Cancer Pain Relief and Palliative Care in Children

“Cancer Incidence in Five Continents (CI5)” is the result of the fruitful collaboration between the International Agency for Research on Cancer and the network for cancer registries worldwide represented by the International Association of Cancer Registries.

This book provides a comprehensive guide to the relief of pain and other symptoms in children suffering from cancer. Drawing on considerable new knowledge about pain control in children, the book aims to ensure that paediatric oncologists and other health professionals have all the information and arguments needed to relieve pain, improve quality of life and reduce the distress of patients and their families. Recommended lines of action are specific to the unique way in which children experience pain and respond to both pain-relieving medication and non-drug measures.

Information ranges from a tabular summary of the advantages and disadvantages of different routes for administering analgesics to children, through a list of drugs, which should not be used in newborns and infants, to the simple observation that older children may deny their pain for fear of more painful treatment. Advice on the management of symptoms related to the disease process or arising from its treatment is also provided in this comprehensive account.

The book opens with facts and figures indicating the global magnitude of problems related to childhood cancer and the large percentage of patients who will experience severe pain. Reasons for the widespread inadequacy of pain control are also discussed. These include exaggerated fears of drug addiction, lack of knowledge about the way children perceive pain, misunderstanding of the pharmacodynamics and pharmacokinetics of opioid analgesics in children, use of inappropriate drug doses, and failure to appreciate the value of simple non-drug supportive measures. Readers are reminded that, with commitment and the appropriate use of available technology, most of the world's childhood cancer patients can receive both pain relief and palliative care, even if cure is impossible.

Against this background, the book presents concise clinical advice in two parts. Part one discusses the components of palliative care, stressing the need to provide pain relief within the context of a holistic approach that recognizes children's psychological, social and spiritual problems. A discussion of the main types of pain in childhood cancer makes a distinction between developed countries, where most pain arises from diagnostic and therapeutic procedures, and the developing world where diagnosis is often late and most pain is therefore disease-related.

The second and most extensive part provides a detailed guide to therapeutic strategies, giving major attention to the correct prescribing of analgesic drugs. A description of the principles of pain assessment in children is followed by practical advice on the use of simple behavioral, cognitive, and supportive pain-relieving measures, many of which can be provided by parents or siblings. Since analgesic drugs are regarded as the mainstay of pain relief, subsequent sections provide precise guidelines for analgesic drug therapy, describe specific drugs and recommended doses for pain relief in different situations, and explain appropriate ways of treating the predictable side-effects of opioids. A section dealing with the issue of opioid dependence and tolerance presents facts and arguments that can ease the fears of parents and help ensure that severe pain is treated with adequate doses of opioids.

Other sections explain the use of adjuvant therapy to elevate mood, reduce anxiety levels, or minimize the adverse side-effects of the primary analgesic drugs and discuss the management of pain caused by diagnostic and therapeutic procedures. In line with the call for a holistic approach to care, advice is also given on the spiritual needs of children and families on care for the dying child, and on related ethical issues including euthanasia and physician-assisted suicide. The guide concludes with discussions of priorities in professional education, legislative and policy issues and requirements for the organization of cancer pain relief programs.

Compassionate as well as authoritative, the book will prove useful to all health workers engaged in the care of children with cancer. The book is a companion to WHO's classic guide Cancer Pain Relief.