60 Use of ambulatory PCA for children and young people with advanced cancer: evaluation of Use and Outcome. (15th December 2021)

• Record Type: Journal Article
• Authors: Patel, Bhumik; Bayliss, Julie; McCulloch, Renee; Criag, Finella; Rajapakse, Dilini; Koh, Michelle; Comac, Margaret; Hemsley, June; Dewar, Chloe; Bell, Charlotte; Bluebond-Langner, Myra
• Is Part Of: Archives of disease in childhood. Volume 106(2021)Supplement 3
• Page Start: A22
• Page End: A23
• Publication Date: 2021-12-15
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2021-gosh.60
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Background: Pain is a leading symptom in children and young people (CYP) with advanced cancer. A multi-modal pain management approach is fundamental in paediatric palliative care. Despite this, pain is only effectively managed in 30% of patients. Use of ambulatory patient-controlled analgesia (PCA) for CYP at home is increasingly described as a safe and effective tool for managing pain in CYP towards the end of life (EOL). Aim: Evaluate use and outcome of ambulatory PCA using a CADD Solis 2100 infusion pump for CYP with advanced cancer cared for at home. Method: Nineteen-month retrospective chart review of CYP with advanced cancer receiving specialist palliative care at home. Results: Ten CYP, 8 males and 2 females aged 3 to 16 years, were started on PCA. One child was excluded as they returned to inpatient care. 9 children managed in the community were evaluated. Median duration of use was 6 days (3 to 140 days). All CYP continued on ambulatory PCA until EOL. Mean number of PCA bolus doses given was 275 bolus/CYP or 13 boluses/day per CYP. In all 9 cases bolus delivery was facilitated by parent/carer proxy. Medications delivered by PCA were: morphine and ketamine (4 cases), oxycodone and ketamine (3 cases), and methadone (2 cases). 1 patient required opioid rotation from PCA initiation to EOL; another CYP required midazolam added to the PCA for severe dyspnoea. On average each patient needed 6 dose adjustments for effective analgesia. Median intravenous morphine equivalent dose at EOL was 0.96 mg/kg/day (range 0.38 to 42.24 mg/kg/day). No adverse events noted. One CYP experienced remote dose cord failure but was still able to receive PCA bolus via pump back up button. Conclusion: Study provides further evidence that ambulatory PCA using CADD pumps can be used successfully and effectively in pain management at home.