Easing of suffering in children with cancer at the end of life: is care changing?.

Title

Easing of suffering in children with cancer at the end of life: is care changing?.

Creator

Wolfe J; Hammel JF; Edwards KE; Duncan J; Comeau M; Breyer J; Aldridge SA; Grier HE; Berde C; Dussel V; Weeks JC

Publisher

Journal Of Clinical Oncology

Date

2008

Subject

Child; Humans; Cohort Studies; Resuscitation Orders; Psychological; Stress; DNAR; Oncology at EOL; Neoplasms/th [Therapy]; Palliative Care/mt [Methods]; Palliative Care/td [Trends]

Description

PURPOSE: In the past decade studies have documented substantial suffering among children dying of cancer, prompting national attention on the quality of end-of-life care and the development of a palliative care service in our institutions. We sought to determine whether national and local efforts have led to changes in patterns of care, advanced care planning, and symptom control among children with cancer at the end of life., METHODS: Retrospective cohort study from a US tertiary level pediatric institution. Parent survey and chart review data from 119 children who died between 1997 and 2004 (follow-up cohort) were compared with 102 children who died between 1990 and 1997 (baseline cohort)., RESULTS: In the follow-up cohort, hospice discussions occurred more often (76% v 54%; adjusted risk difference [RD], 22%; P < .001) and earlier (adjusted geometric mean 52 days v 28 days before death; P = .002) compared with the baseline cohort. Do-not-resuscitate orders were also documented earlier (18 v 12 days; P = .031). Deaths in the intensive care unit or other hospitals decreased significantly (RD, 16%; P = .024). Parents reported less child suffering from pain (RD, 19%; P = .018) and dyspnea (RD, 21%; P = .020). A larger proportion of parents felt more prepared during the child's last month of life (RD, 29%; P < .001) and at the time of death (RD, 24%; P = .002)., CONCLUSION: Children dying of cancer are currently receiving care that is more consistent with optimal palliative care and according to parents, are experiencing less suffering. With ongoing growth of the field of hospice and palliative medicine, further advancements are likely.
2008

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Citation

Wolfe J; Hammel JF; Edwards KE; Duncan J; Comeau M; Breyer J; Aldridge SA; Grier HE; Berde C; Dussel V; Weeks JC, “Easing of suffering in children with cancer at the end of life: is care changing?.,” Pediatric Palliative Care Library, accessed February 6, 2023, https://pedpalascnetlibrary.omeka.net/items/show/14042.

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