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Palliative medicine

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G86 USE OF STRONG OPIOIDS AT THE END OF LIFE IN CANCER PATIENTS

V. Lidstone1, J. Hardy1, R. Pinkerton2. 1Paediatric Palliative Care team; 2Department of Paediatric Oncology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK

Objective: To investigate and quantify use of strong opioids at the end of life in children with cancer.

Design and Setting: Retrospective review of case notes at a large cancer centre in Sutton, Surrey, UK.

Subjects: Children aged 1 month–19 years under the care of the paediatric oncology outreach service at the study centre, who had reached the palliative phase of their illness and died between 01 January 2001 and 01 January 2003.

Results: 40 cases were available for analysis. Thirty five patients received strong opioids during the last illness (brain/spinal n = 10; solid tumours n = 15; leukaemias n = 10). Diamorphine was the most common preparation used, given via the intravenous route. Dose and duration of treatment varied widely. Weights were available for 25/35 patients and for this group the median dose on the day strong opioids were started was 1.0 mg/kg/day oral. Morphine equivalent (OME) (mean 6.2 mg, 0–58.2 mg), and on the last day of life was 4.8mg/kg/day OME (mean 55.8 mg, range 0–1100 mg).

Conclusions: Strong opioids were required by most but not all children at the end of life. Those with solid tumours required treatment for the longest period, those with leukaemias required the highest dose on the last day of life, and those with brain/spinal tumours the lowest.

G87 A STUDY OF THE SYMPTOMS AND INTERVENTIONS DURING THE PALLIATIVE PHASE IN CENTRAL NERVOUS SYSTEM (CNS) TUMOURS

R. Sinha, M. Breen, D. Hargrave. Paediatric Oncology Unit, Royal Marsden Hospital, Sutton

Introduction: CNS tumours are the commonest cause of oncological death in the paediatric population. Palliative symptom management is a vital part of the holistic care of these children. Many of the symptoms differ from those of other malignancies and present unique challenges to providing effective palliative care. …

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