Flerlage, J.E., & Baker, J.N. (2015). Methylnaltrexone for opioid-induced constipation in children and adolescents and young adults with progressive incurable cancer at the end of life. Journal of Palliative Medicine, 18, 631–633. 

DOI Link

Study Purpose

To describe the use of methylnaltrexone (MNTX) in pediatric patients with cancer in both inpatient and outpatient settings

Intervention Characteristics/Basic Study Process

A retrospective chart review was conducted on all children, adolescents, and young adults with incurable cancer treated at St. Jude Hospital from May 2008 to June 2013. Pharmacy data and chart data were reviewed for inclusion data. Patients had documented OIC and the administration of enteral preparations and/or suppositories to treat OIC. After standard therapy for OIC was not successful, MNTX was administered subcutaneously at 0.15 mg/kg per dose.

Sample Characteristics

  • N = 9  
  • AGE RANGE = 17 months-21 years
  • MALES: 44%, FEMALES: 56%
  • KEY DISEASE CHARACTERISTICS: Progressive, incurable cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: Children, adolescent, and young adult

Setting

  • SITE: Single site  
  • SETTING TYPE: Multiple settings    
  • LOCATION: Memphis, TN

Phase of Care and Clinical Applications

  • PHASE OF CARE: End-of-life care
  • APPLICATIONS: Pediatrics and palliative care 

Study Design

  • Retrospective chart review (RCR)

Measurement Instruments/Methods

  • Data collection tool specific to this study was used.

Results

MNTX administration produced bowel function in seven (78%) of the patients in one hour and with five (71%) of the patients having a response to first dose. With repeated dosing, 71% had continued response. There were no side effects documented. Two patients responded to repeated doses. The drug was effective in four of five patients with intra-abdominal disease.

Conclusions

The study revealed that MNTX can be safe and effective in children, adolescents, and young adults with OIC and end-of-life disease.

Limitations

  • Small sample (less than 30)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment) 
  • Risk of bias (no appropriate attentional control condition)
  • Measurement/methods not well described
  • Measurement validity/reliability questionable
  • Findings not generalizable

Nursing Implications

OIC is a distressing side effect of opioid pain management. The use of MNTX in pediatric patients with cancer with progressive disease appears to be an effective and safe in this retrospective audit, but prospective randomized clinical trials are required.