Defining and Timing of Palliative Opportunities in Children with Central Nervous System Tumors

Title

Defining and Timing of Palliative Opportunities in Children with Central Nervous System Tumors

Creator

Massie AM; Ebelhar J; Allen KE; DeGroote NP; Wasilewski-Masker K; Brock KE

Identifier

Publisher

Neuro-Oncology Practice

Date

2021

Subject

central nervous system; oncology; pediatric palliative care; brain tumor; palliative opportunity

Description

BACKGROUND: Children with brain and central nervous system (CNS) tumors experience substantial challenges to their quality of life during their disease course. These challenges are opportunities for increased subspecialty palliative care (PC) involvement. Palliative opportunities have been defined in the pediatric oncology population, but the frequency, timing, and factors associated with palliative opportunities in pediatric patients with CNS tumors are unknown. METHODS: A single-institution retrospective review was performed on children ages 0-18 diagnosed with a CNS tumor who died between January 1, 2012 and November 30, 2017. Nine palliative opportunities were defined prior to data collection (progression, relapse, admission for severe symptoms, intensive care admission, bone marrow transplant, phase 1 trial, hospice, do-not-resuscitate (DNR) order). Demographic, disease, treatment, palliative opportunity, and end-of-life data were collected. Opportunities were evaluated over quartiles from diagnosis to death. RESULTS: Amongst 101 patients with a median age at death of eight years (interquartile range [IQR] = 8.0, range 0-22), there was a median of seven (IQR = 6) palliative opportunities per patient, which increased closer to death. PC consultation occurred in 34 (33.7%) patients, at a median of 2.2 months before death, and was associated with having a DNR order (P = .0028). Hospice was involved for 72 (71.3%) patients. CONCLUSION: Children with CNS tumors suffered repeated events warranting PC yet received PC support only one-third of the time. Mapping palliative opportunities over the cancer course promotes earlier timing of PC consultation which can decrease suffering and resuscitation attempts at the end-of-life.

Rights

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Citation List Month

2021 Special Edition - Oncology

Citation

Massie AM; Ebelhar J; Allen KE; DeGroote NP; Wasilewski-Masker K; Brock KE, “Defining and Timing of Palliative Opportunities in Children with Central Nervous System Tumors,” Pediatric Palliative Care Library, accessed May 20, 2024, https://pedpalascnetlibrary.omeka.net/items/show/18950.