Background: Cancer pain in paediatric patients represents a major clinical challenge, particularly in advanced disease and palliative care settings. Methadone has been proposed as an alternative for refractory pain due to its unique pharmacological profile.
Objective: To evaluate the available evidence on the efficacy and safety of methadone in paediatric oncology patients receiving palliative care.
Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A search was performed in PubMed/MEDLINE (11 February 2026) using terms related to methadone, paediatric cancer and palliative care. Studies including patients aged 0–17 years treated with methadone for cancer-related pain were included. A qualitative narrative synthesis was performed.
Results: Eleven studies were included, primarily retrospective studies and case series. Methadone was associated with significant improvement in pain control, reduced pain intensity and decreased need for rescue medication. Dosing regimens varied widely. The incidence of clinically significant QT interval prolongation was low, with no reported serious arrhythmias. Adverse effects were mostly mild.
Conclusion: Methadone appears to be an effective and generally safe alternative for managing refractory cancer pain in paediatric patients. However, evidence is limited, highlighting the need for prospective studies. These findings support the cautious integration of methadone into paediatric palliative care protocols under appropriate monitoring.
