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Attitudes and Practices of Pediatric Oncologists Regarding Methadone Use in the Treatment of Cancer-related Pain: Results of a North American Survey

Roth, Michael MD; Davies, Dawn MD; Friebert, Sarah MD; Wang, Dan MS; Kim, Mimi Sc.D; Zelcer, Shayna MD

Journal of Pediatric Hematology/Oncology: March 2013 - Volume 35 - Issue 2 - p 103–107
doi: 10.1097/MPH.0b013e318279e492
Original Articles

Methadone is effective in the treatment of cancer-related pain in adults. Pediatric oncologists may be reluctant to use methadone, given the paucity of existing research and a lack of familiarity with its use. This study’s purpose was to assess pediatric oncologists’ experience, comfort and practice of methadone prescription, and determine interest in and appropriate venues for education on methadone. A 22-item survey was sent by electronic mail to 1912 practicing pediatric oncologists. Six hundred thirty-one pediatric oncologists (33%) responded to the survey. Seventy-two percent of respondents reported they prescribe methadone to <10% of their patients receiving opioids. Physicians practicing ≥10 years (84% vs. 76%, P=0.01), at centers that see ≥100 new patients per year (86% vs. 76%, P=0.003), or who have received prior education on methadone (89% vs. 54%, P<0.001) were more likely to have prescribed methadone. The primary reasons respondents did not utilize methadone included a lack of knowledge of methadone’s pharmacodynamics (39%), effectiveness (39%), and/or dosing equivalence (34%). Perceived competence with dose equivalence, belief that methadone is effective, and working in a division where >20 patients per year died were all independently associated with having prescribed methadone to >10% of patients on opioids. Eighty-five percent of respondents would like additional education on methadone. Many pediatric oncologists lack experience and education in the use of methadone. Formal education initiatives should be implemented to enhance pediatric oncologists’ comfort and expertise in methadone use.

*Department of Pediatrics, Division of Pediatric Hematology/Oncology, Children’s Hospital at Montefiore

§Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY

Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada

Haslinger Division of Pediatric Palliative Care, Akron Children’s Hospital, Akron, OH

Division of Pediatric Hematology/Oncology, Children’s Hospital, London Health Sciences Center, London, ON, Canada

The authors declare no conflict of interest.

Reprints: Michael Roth, MD, Department of Pediatrics, Division of Hematology/Oncology, Children’s Hospital at Montefiore, 111 East 210th Street, Rosenthal Pavilion, 3rd Floor, Bronx, NY 10467 (e-mail:

Received December 27, 2011

Accepted August 22, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.