Vol. 22, No. 2
Books and Publications
Publication from the World Health Organization
Cancer Pain Relief and Palliative Care in Children
1998, ix + 76 pages (available in English; French and Spanish in preparation),
ISBN 92-4-154512-7, CHF 18.-/USD 16.20; In developing countries: CHF
12.60, Order No. 1150459.
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 pediatric 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 that 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 reasons include
exaggerated fears of drug addiction, 1ack 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 1 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. Because 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
Compassionate as well as authoritative, the book should prove useful
to all health workers engaged in the care of children with cancer.