Symptom Management at the end of Life in Pediatric Oncology
Juliana Mariani
Howard J. Weinstein
Symptoms and Suffering at the End of Life in Children With Cancer
Wolfe J, Grier HE, Klar N, et al. N Engl J Med. 2000;342(5):326–333
Background
There are 15,000 new pediatric cancer diagnoses and approximately 3,000 deaths annually making cancer the leading cause of nonaccidental death in childhood. Pediatric oncology patients often receive aggressive treatment with a goal of cure even at the end of life, raising concerns about whether care adequately addresses suffering. Palliative care services are part of the standard of care, though implementation varies. This study was one of the first to assess the practices and quality of end of life care in pediatric oncology.
Objectives
To describe the delivery of care and symptom presence and management in the last month of life, as well as factors related to suffering in pediatric patients with cancer.
Methods
Interview of parents from 1997 to 1998 whose children died from cancer between 1990 and 1997 at 2 US academic centers.
Patients
107 parents whose children died >1 year prior. Select exclusion criteria: non-English speaking, living outside of North America.
Intervention
Data obtained from medical charts and structured parental interviews about the presence and severity of children’s symptoms, including pain, poor appetite, nausea, vomiting, constipation, diarrhea, dyspnea, fatigue, and quality of life, as well as how these symptoms were managed. Parents were queried about physician involvement at end of life.
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