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Pérez-Torres Lobato M, Navarro-Marchena L, de Noriega I, Morey Olivé M, Solano-Páez P, Rubio Pérez E, Garrido Colino C, García Abos M, Tallón García M, Huidobro Labarga B, Portugal Rodríguez R, López Ibor B, Lassaletta Á, Morgenstern Isaak A, Cruz Martínez O, Valero Arrese L, Llort Sales A, Gros Subias L, Márquez Vega C, Moreno L, Quiroga-Cantero E. Palliative care for children with central nervous system tumors: results of a Spanish multicenter study. Clin Transl Oncol 2024; 26:786-795. [PMID: 37646983 DOI: 10.1007/s12094-023-03301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Brain tumors represent the most common cause of cancer-related death in children. Few studies concerning the palliative phase in children with brain tumors are available. OBJECTIVES (i) To describe the palliative phase in children with brain tumors; (ii) to determine whether the use of palliative sedation (PS) depends on the place of death, the age of the patient, or if they received specific palliative care (PC). METHODS Retrospective multicenter study between 2010 and 2021, including children from one month to 18 years, who had died of a brain tumor. RESULTS 228 patients (59.2% male) from 10 Spanish institutions were included. Median age at diagnosis was 5 years (IQR 2-9) and median age at death was 7 years (IQR 4-11). The most frequent tumors were medulloblastoma (25.4%) and diffuse intrinsic pontine glioma (DIPG) (24.1%). Median number of antineoplastic regimens were 2 (range 0-5 regimens). During palliative phase, 52.2% of the patients were attended by PC teams, while 47.8% were cared exclusively by pediatric oncology teams. Most common concerns included motor deficit (93.4%) and asthenia (87.5%) and communication disorders (89.8%). Most frequently prescribed supportive drugs were antiemetics (83.6%), opioids (81.6%), and dexamethasone (78.5%). PS was administered to 48.7% patients. Most of them died in the hospital (85.6%), while patients who died at home required PS less frequently (14.4%) (p = .01). CONCLUSION Children dying from CNS tumors have specific needs during palliative phase. The optimal indication of PS depended on the center experience although, in our series, it was also influenced by the place of death.
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Affiliation(s)
- Maria Pérez-Torres Lobato
- Division of Pediatric Hematology and Oncology, Vall d'Hebrón Hospital, Pg. de La Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Lucía Navarro-Marchena
- Palliative Care and Complex Chronic Patient Service, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Iñigo de Noriega
- Pediatric Palliative Care Unit, Niño Jesús Hospital, Madrid, Spain
| | - Miriam Morey Olivé
- Division of General Pediatrics, Vall d'Hebrón Hospital, Barcelona, Spain
| | | | - Eloísa Rubio Pérez
- Methodological and Statistical Management Unit, FISEVI, Virgen del Rocio Hospital, Seville, Spain
| | | | | | | | | | | | | | - Álvaro Lassaletta
- Division of Pediatric Hematology and Oncology, Niño Jesús Hospital, Madrid, Spain
| | | | - Ofelia Cruz Martínez
- Division of Pediatric Hematology and Oncology, Pediatric Cancer Center Barcelona, Barcelona, Spain
| | - Lorena Valero Arrese
- Division of Pediatric Hematology and Oncology, Vall d'Hebrón Hospital, Pg. de La Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Anna Llort Sales
- Division of Pediatric Hematology and Oncology, Vall d'Hebrón Hospital, Pg. de La Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Luis Gros Subias
- Division of Pediatric Hematology and Oncology, Vall d'Hebrón Hospital, Pg. de La Vall d'Hebron, 119, 08035, Barcelona, Spain
| | | | - Lucas Moreno
- Division of Pediatric Hematology and Oncology, Vall d'Hebrón Hospital, Pg. de La Vall d'Hebron, 119, 08035, Barcelona, Spain.
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Podda MG, Schiavello E, Nigro O, Clerici CA, Simonetti F, Luksch R, Terenziani M, Ferrari A, Casanova M, Spreafico F, Meazza C, Chiaravalli S, Biassoni V, Gattuso G, Puma N, Bergamaschi L, Sironi G, Massimino M. Palliative sedation in paediatric solid tumour patients: choosing the best drugs. BMJ Support Palliat Care 2024; 13:e1141-e1148. [PMID: 36418035 DOI: 10.1136/bmjspcare-2022-003534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Cancer remains the leading cause of mortality by disease in childhood in high-income countries. For terminally ill children, care focuses on quality of life, and patient management fundamentally affects grieving families. This paper describes our experience of palliative sedation (PS) for children with refractory symptoms caused by solid tumours, focusing on the drugs involved. METHODS We retrospectively collected data on all children treated for cancer who died at the pediatric oncology unit of the Fondazione IRCCS Istituto Nazionale dei Tumori between January 2016 and December 2020. RESULTS Of the 29 patients eligible for the study, all but 4 received PS. Midazolam was always used, combined in 16 cases with other drugs (mainly classic neuroleptics, alpha-2 agonists and antihistamines). Throughout the period of PS and on the day of death, patients with sarcoma were given higher doses of midazolam and morphine, and more often received combinations of drugs than patients with brain tumours. Sarcoma causes significant symptoms, while brain tumours require less intensive analgesic-sedative therapies because they already impair a patient's state of consciousness. CONCLUSIONS Optimising pharmacological treatments demands a medical team that knows how drugs (often developed for other indications) work. Emotional and relational aspects are important too, and any action to lower a patient's consciousness should be explained to the family and justified. Parents should not feel like helpless witnesses. Guidelines on PS in paediatrics could help, providing they acknowledge that a child's death is always a unique case.
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Affiliation(s)
- Marta Giorgia Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Alfredo Clerici
- Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Department of Oncology and Hematology, Università degli Studi di Milano, Milano, Italy
| | - Fabio Simonetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Givanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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3
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Pierron C, Levy M, Mattioni V, Poncelet G, Le Bourgeois F. Perceptible Signs of End of Life in Pediatric Intensive Care Patients. J Palliat Med 2022; 25:1829-1834. [PMID: 36137014 DOI: 10.1089/jpm.2021.0582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: How children die in pediatric intensive care units (PICUs) has been poorly described, and support for parents during this traumatic experience could be improved. Better information on perceptible signs of the end of life (EOL) in children may help mitigate the trauma. Objective: To describe the most common perceptible EOL signs in PICU patients. Methods: A prospective study in a PICU. Health care providers observed 28 children expected to die and noted the perceptible signs. Results: The most common perceptible signs were desaturation and bradycardia. Twenty-seven patients had at least one change in physical appearance. Gasping was noted in 12 patients. Conclusion: Perceptible signs of the EOL were different from those reported in children dying in other units or in adults. Sharing information about signs of EOL with parents may prepare them and enable them to better support their child.
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Affiliation(s)
- Charlotte Pierron
- Neonatal and Pediatric Intensive Care Unit, Hospital Center of Luxembourg-KannerKlinik, Luxembourg, Luxembourg
| | - Michaël Levy
- Pediatric Intensive Care Unit, Robert-Debré University Hospital, Paris, France
| | - Violaine Mattioni
- Medical Oncology Department, Saint Louis University Hospital, Paris, France
| | - Géraldine Poncelet
- Pediatric Intensive Care Unit, Robert-Debré University Hospital, Paris, France
| | - Fleur Le Bourgeois
- Pediatric Intensive Care Unit, Robert-Debré University Hospital, Paris, France
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Silverstein A, Butia M, Bank R, Manda G, Nyasulu C, Mwango N, Makuti S, Chikasema M, Torrey S, Hesselgrave J, Casas J, Thambo L, Msekandiana A, Chiume M, Ozuah N, Huibers MH. Palliative Care Services within a Pediatric Hematology-Oncology Program in a Low-Resource Setting. J Pain Symptom Manage 2022; 63:e473-e480. [PMID: 35031502 DOI: 10.1016/j.jpainsymman.2022.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Outcomes for children with cancer in sub-Saharan Africa (SAA) are dismal due to delayed diagnosis and limited access to curative therapy. When establishing a pediatric hematology-oncology (PHO) program in low-resource settings, early integration of palliative care services becomes essential. While palliative care is a human right, equitable distribution is lacking. OBJECTIVES We aim to describe our experience establishing a palliative care program, the services offered, and the distribution of patients served. METHODS This is a brief description of our PHO palliative care program in Lilongwe, Malawi at a tertiary care center and a three-year retrospective review of activities (2017-2020). Services offered include inpatient, outpatient, home visits, end of life care, and strengthening of referral systems. RESULTS Over the three-year period, 315 patients were enrolled. 57% (n=179) were male. The median age was seven years (5 months-22 years). Patients served were from 17 of 28 districts within Malawi. Diagnoses of patients included 43% solid tumors (n=135), 22% lymphoma (n=68), 15% leukemia (n=47), and 21% hematologic disease (n=65). 40% of patients have died (n=125), with 53% of deaths occurring at home (n=66), 22% in the hospital (n=28), and 25% at unknown locations (n=31). CONCLUSION Palliative care is a critical component of PHO programs worldwide. Programs must leverage existing networks to ensure optimal care to children and families. We demonstrate the feasibility of integrating palliative care services within a PHO program in a low-resource setting, which could serve as a model for other countries in SSA.
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Affiliation(s)
- Allison Silverstein
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (A.S., S.T., J.H., J.C., N.O., M.H.H.), Texas Children's Hospital, Houston, Texas, USA; Department of Pediatrics (A.S., S.T., J.H., J.C., N.O., M.H.H.), Baylor College of Medicine, Houston, Texas USA.
| | - Mercy Butia
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (M.B., R.B., G.M., C.N., N.M., S.M., N.O., M.H.H.), Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Rhahim Bank
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (M.B., R.B., G.M., C.N., N.M., S.M., N.O., M.H.H.), Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Geoffrey Manda
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (M.B., R.B., G.M., C.N., N.M., S.M., N.O., M.H.H.), Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Constance Nyasulu
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (M.B., R.B., G.M., C.N., N.M., S.M., N.O., M.H.H.), Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Noel Mwango
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (M.B., R.B., G.M., C.N., N.M., S.M., N.O., M.H.H.), Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Samuel Makuti
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (M.B., R.B., G.M., C.N., N.M., S.M., N.O., M.H.H.), Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Maria Chikasema
- University of North Carolina Project-Malawi (M.C.), Lilongwe, Malawi
| | - Susan Torrey
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (A.S., S.T., J.H., J.C., N.O., M.H.H.), Texas Children's Hospital, Houston, Texas, USA; Department of Pediatrics (A.S., S.T., J.H., J.C., N.O., M.H.H.), Baylor College of Medicine, Houston, Texas USA
| | - Joy Hesselgrave
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (A.S., S.T., J.H., J.C., N.O., M.H.H.), Texas Children's Hospital, Houston, Texas, USA; Department of Pediatrics (A.S., S.T., J.H., J.C., N.O., M.H.H.), Baylor College of Medicine, Houston, Texas USA
| | - Jessica Casas
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (A.S., S.T., J.H., J.C., N.O., M.H.H.), Texas Children's Hospital, Houston, Texas, USA; Department of Pediatrics (A.S., S.T., J.H., J.C., N.O., M.H.H.), Baylor College of Medicine, Houston, Texas USA
| | - Lameck Thambo
- Palliative Care Association of Malawi (L.T.), Lilongwe, Malawi
| | - Amos Msekandiana
- Department of Pediatrics (A.M., M.C.), Kamuzu Central Hospital, Lilongwe, Malawi
| | - Msandeni Chiume
- Department of Pediatrics (A.M., M.C.), Kamuzu Central Hospital, Lilongwe, Malawi
| | - Nmazuo Ozuah
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (A.S., S.T., J.H., J.C., N.O., M.H.H.), Texas Children's Hospital, Houston, Texas, USA; Department of Pediatrics (A.S., S.T., J.H., J.C., N.O., M.H.H.), Baylor College of Medicine, Houston, Texas USA; Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (M.B., R.B., G.M., C.N., N.M., S.M., N.O., M.H.H.), Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Minke Hw Huibers
- Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (A.S., S.T., J.H., J.C., N.O., M.H.H.), Texas Children's Hospital, Houston, Texas, USA; Department of Pediatrics (A.S., S.T., J.H., J.C., N.O., M.H.H.), Baylor College of Medicine, Houston, Texas USA; Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (M.B., R.B., G.M., C.N., N.M., S.M., N.O., M.H.H.), Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
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Greenfield DK, Carter B, Harrop DE, Jassal DS, Bayliss MJ, Renton DK, Holley DS, Howard DRF, Johnson MM, Liossi C. Healthcare Professionals' Experiences of the Barriers and Facilitators to Pediatric Pain Management in the Community at End-of-Life: A Qualitative Interview Study. J Pain Symptom Manage 2022; 63:98-105. [PMID: 34273522 DOI: 10.1016/j.jpainsymman.2021.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/22/2022]
Abstract
CONTEXTS Inadequate pain management in community pediatric palliative care is common. Evidence to inform improved pain management in this population is limited. OBJECTIVES To explore the barriers and facilitators to pediatric community-based pain management for infants, children and young people at end-of-life as perceived by healthcare professionals. METHODS A qualitative interview study was conducted. Semi-structured interviews were undertaken with 29 healthcare professionals; 12 nurses, five GPs, five consultants and registrar doctors, two pharmacists and five support therapists working in primary, secondary or tertiary care in the United Kingdom and involved in community end-of life care of 0 to 18-year-olds. RESULTS The data corpus was analyzed using an inductive thematic analysis and seven themes emerged: parents' abilities, beliefs and wellbeing; working relationships between families and healthcare professionals, and between healthcare teams; healthcare professionals' knowledge, education and experience; health services delivery; nature of pain treatment; and pediatric-specific factors. Across themes, the concepts of partnership working between families and healthcare professionals, and within healthcare teams, and sharing expertise were prevalent. CONCLUSION Partnership working and trust between healthcare professionals and parents, and within healthcare teams, is needed for effective at-home pediatric palliative pain management. Community healthcare professionals require more education from experienced multidisciplinary teams to effectively manage pediatric pain at end-of-life and prevent emergency hospice or hospital admissions, particularly during the COVID-19 pandemic.
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Affiliation(s)
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
| | - Dr Emily Harrop
- Helen & Douglas House Hospices, Oxford, Oxfordshire, UK; Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford, UK
| | | | - Ms Julie Bayliss
- Great Ormond Street Hospital for Children NHS Foundation Trust, The Louis Dundas Centre, London, UK
| | - Dr Kate Renton
- University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton, Hampshire, UK; Naomi House & Jacksplace, Winchester, Hampshire, UK
| | | | - Dr Richard F Howard
- Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Anaesthesia and Pain Medicine Level 4, London, UK
| | | | - Christina Liossi
- School of Psychology, University of Southampton, Highfield, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, The Louis Dundas Centre, London, UK.
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6
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Podda MG, Schiavello E, Clerici CA, Luksch R, Terenziani M, Ferrari A, Casanova M, Spreafico F, Meazza C, Biassoni V, Chiaravalli S, Puma N, Bergamaschi L, Gattuso G, Sironi G, Nigro O, Massimino M. Children and adolescent solid tumours and high-intensity end-of-life care: what can be done to reduce acute care admissions? BMJ Support Palliat Care 2021:bmjspcare-2021-003031. [PMID: 34493535 DOI: 10.1136/bmjspcare-2021-003031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/17/2021] [Indexed: 11/03/2022]
Abstract
Despite improvements in survival, cancer remains the leading cause of non-accidental death in children and adolescents, who risk receiving high-intensity end-of-life (HI-EOL) care. OBJECTIVE To analyse treatments for relapses (particularly in the last weeks of life), assess their impact on the EOL, identify patients most likely to receive HI-EOL care and examine whether palliative care services can contain the intensity of EOL care. METHODS This retrospective study involved patients treated at the paediatric oncology unit of the Istituto Nazionale Tumori in Milan who died between 2018 and 2020. The primary outcome was HI-EOL care, defined as: ≥1 session of intravenous chemotherapy <14 days before death; ≥1 hospitalisation in intensive care in the last 30 days of life and ≥1 emergency room admission in the last 30 days of life. RESULTS The study concerned 68 patients, and 17 had HI-EOL care. Patients given specific in-hospital treatments in the last 14 days of their life more frequently died in hospital. Those given aggressive EOL care were less likely to die at home or in the hospice. Patients with central nervous system (CNS) tumours were more likely to have treatments requiring hospitalisation, and to receive HI-EOL care. CONCLUSION These results underscore the importance of considering specific treatments at the EOL with caution. Treatments should be administered at home whenever possible.The early activation of palliative care, especially for fragile and complicated patients like those with CNS cancers, could help families cope with the many problems they face.
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Affiliation(s)
- Marta Giorgia Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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7
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Blais S, Cohen-Gogo S, Gouache E, Guerrini-Rousseau L, Brethon B, Rahal I, Petit A, Raimondo G, Pellegrino B, Orbach D. End-of-life care in children and adolescents with cancer: perspectives from a French pediatric oncology care network. TUMORI JOURNAL 2021; 108:223-229. [PMID: 33940999 DOI: 10.1177/03008916211013384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In developed countries, cancer remains the leading cause of pediatric death from illness after the neonatal period. OBJECTIVE To describe the end-of-life care characteristics of children and adolescents with solid tumors (ST) or hematologic malignancies (HM) who died from tumor progression in the Île-de-France area. METHODS This is a regional, multicentric, retrospective review of medical files of all children and adolescents with cancer who died over a 1-year period. Extensive data from the last 3 months of life were collected. RESULTS A total of 99 eligible patients died at a median age of 9.8 years (range, 0.3-24 years). The most frequent terminal symptoms were pain (n = 86), fatigue (n = 84), dyspnea (n = 49), and anorexia (n = 41). Median number of medications per patient was 8 (range, 3-18). Patients required administration of opioids (n = 91), oxygen (n = 36), and/or sedation (n = 61). Decision for palliative care was present in all medical records and do-not-resuscitate orders in 90/99 cases. Symptom prevalence was comparable between children and adolescents with ST and HM. A wish regarding the place of death had been expressed for 64 patients and could be respected in 42 cases. Death occurred in hospital for 75 patients. CONCLUSIONS This study represents a large and informative cohort illustrating current pediatric palliative care approaches in pediatric oncology. End-of-life remains an active period of care requiring coordination of multiple care teams.
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Affiliation(s)
- Sophie Blais
- Pediatric Department, Poissy Hospital, Poissy, France
| | - Sarah Cohen-Gogo
- Division of Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Elodie Gouache
- Department of Pediatric Hematology, Trousseau Hospital (AP-HP), Sorbonne University, Paris, France
| | - Lea Guerrini-Rousseau
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Paris-Saclay University, Villejuif, France
| | - Benoit Brethon
- Pediatric Hematology Department, Robert Debré Hospital (AP-HP), Paris, France.,RIFHOP, Île-de-France Regional Network of Pediatric Hematology-Oncology, Paris, France
| | - Ilhem Rahal
- Adolescents and Young Adults Hematology Department, Saint-Louis Hospital (AP-HP), Paris, France
| | - Arnaud Petit
- Department of Pediatric Hematology, Trousseau Hospital (AP-HP), Sorbonne University, Paris, France
| | - Graziella Raimondo
- Department of Pediatric Hematology and Oncology, Hôpital d'Enfants Margency, Margency, France.,PALIPED, Regional Pediatric Palliative Care Resource Team of Île-de-France, Paris, France
| | - Beatrice Pellegrino
- Pediatric Department, Poissy Hospital, Poissy, France.,RIFHOP, Île-de-France Regional Network of Pediatric Hematology-Oncology, Paris, France.,PALIPED, Regional Pediatric Palliative Care Resource Team of Île-de-France, Paris, France
| | - Daniel Orbach
- RIFHOP, Île-de-France Regional Network of Pediatric Hematology-Oncology, Paris, France.,SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
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De Zen L, Del Rizzo I, Ronfani L, Barbieri F, Rabusin M, Dall'Amico R, Barbi E, Robazza M. Safety and family satisfaction of a home-delivered chemotherapy program for children with cancer. Ital J Pediatr 2021; 47:43. [PMID: 33637114 PMCID: PMC7908006 DOI: 10.1186/s13052-021-00993-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home chemotherapy programs for children with cancer are safe and feasible, and their impact on the quality of life has been reported in different countries. A home chemotherapy program was implemented between 2011 and 2019 in an Italian region. This pilot study investigates its safety and feasibility, along with parental satisfaction. METHODS Patients between 0 and 18 years diagnosed with malignancy were included. Deceased patients and patients whose families moved abroad or interrupted contact with the service were excluded. Adverse events comprised immediate deterioration of the patient's condition, equipment failure, errors in drug storage, dose or patient identification and personnel safety issues. Parental satisfaction was explored through an email survey of 32 Likert-type and short open questions. RESULTS Thirty-five patients received 419 doses of intravenous chemotherapy at home (cytarabine, vincristine, vinblastine). No adverse events were reported. Twenty-three families out of 25 eligible completed the survey. Most reported being "very satisfied" with the possibility of maintaining a work/domestic routine and reducing time and financial burden of hospital access. Most were "very satisfied" with the opportunity for their child of being less troubled by the treatment. Besides, most reported being "very satisfied" with the chance for healthy siblings of maintaining their routine and coping with their brother/sister's disease. Most perceived the program as safe. All families recommended extending the program to all children in the region. CONCLUSIONS This first Italian study supports home chemotherapy as safe and effective, positively influencing the quality of life for children and their families.
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Affiliation(s)
- Lucia De Zen
- Pediatric Palliative Care and Pain Service, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Irene Del Rizzo
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Luca Ronfani
- Department of Clinical Epidemiology, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Francesca Barbieri
- Pediatric Department, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Marco Rabusin
- Pediatric Department, Oncology and Hematology Unit, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Roberto Dall'Amico
- Pediatric Department, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Egidio Barbi
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.,Pediatric Department, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Margherita Robazza
- Pediatric Department, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
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Podda M, Schiavello E, Visconti G, Clerici CA, Armiraglio M, Casiraghi G, Ambroset S, Grossi A, Rizzi B, Lonati G, Massimino M. Customised pediatric palliative care: Integrating oncological and palliative care priorities. Acta Paediatr 2021; 110:682-688. [PMID: 32544257 DOI: 10.1111/apa.15415] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Abstract
AIM To describe the experience involving the early introduction of palliative care (PC) in oncological patients treated within the paediatric oncology unit of the Istituto Nazionale Tumori of Milan and compare this cohort with a cohort of patients resident in the same area treated before the introduction of early palliative care. METHODS A virtual team was assembled in 2015. The PC providers operate outside the hospital. Conference calls were scheduled to discuss patients' problems. This sample was compared with the clinical records of patients residing in the same area who died between 2009 and 2014. RESULTS Between January 2015 and April 2019, 41 patients residing in the Milan area mainly with CNS tumours or sarcomas were referred to the team. Comparing the results with the previous cohort, there was a rise in the number of patients dying at home or in a hospice and the duration of PC increased over time. From 2015, none of the patients died in an intensive care unit. CONCLUSION Patients managed by the virtual team were able to continue their cancer treatments, take part in Phase I trials and receive PC. All patients with a poor prognosis should have PC at an early stage.
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Affiliation(s)
- Marta Podda
- Pediatric Oncology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milano Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milano Italy
| | - Giovanna Visconti
- Hospice and Palliative Care Unit Casa Sollievo Bimbi, Associazione VIDAS Milano Italy
| | - Carlo Alfredo Clerici
- Milano ‐ Dipartimento di Oncologia ed Emato‐Oncologia SSD Psicologia ClinicaFondazione IRCCS ‐ Istituto Nazionale dei TumoriUniversità di Milano Milano Italy
| | - Mariangela Armiraglio
- Pediatric Oncology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milano Italy
| | - Giovanna Casiraghi
- Pediatric Oncology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milano Italy
| | - Sonia Ambroset
- Psychology Unit Casa Sollievo Bimbi, Associazione VIDAS Milano Italy
| | - Alberto Grossi
- Hospice and Palliative Care Unit Casa Sollievo Bimbi, Associazione VIDAS Milano Italy
| | - Barbara Rizzi
- Hospice and Palliative Care Unit Casa Sollievo Bimbi, Associazione VIDAS Milano Italy
| | - Giada Lonati
- Hospice and Palliative Care Unit Casa Sollievo Bimbi, Associazione VIDAS Milano Italy
| | - Maura Massimino
- Pediatric Oncology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milano Italy
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Das K, Khanna T, Arora A, Agrawal N. Parents' acceptance and regret about end of life care for children who died due to malignancy. Support Care Cancer 2019; 28:303-308. [PMID: 31044306 PMCID: PMC7223103 DOI: 10.1007/s00520-019-04806-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/07/2019] [Indexed: 01/21/2023]
Abstract
Purpose To analyse the preference of end of life care place in paediatric oncology patients, and to understand the end of life care needs and regrets among the care givers. Method This was an observational qualitative study. Parents of in-curable paediatric malignancy patients who died during the years 2016–2018 were interviewed using a pre-formed open-ended questionnaire. Fears during the last phase of child’s life, most disturbing symptoms, choice of end of life care plan, regret of care givers and reasons for such choices were noted and analysed. Result Twenty six families were interviewed. A median of 3 months of discordance was noted between declaration of in-curability and acceptance of the same by the family. During terminal months, pain (84.62%) was described as the most bothersome symptom followed by respiratory distress (73.08%). Eighteen families (69%) opted for home-based terminal care, 8 (31%) for hospital-based terminal care. Regret of choice was noted in 62.5% families of the hospital-based care group (separation from home environment being the main reason) and 38.89% of the home-based care group (lack of access to health care personnel and pain medication being the main reasons). Conclusion Home-based care is the preferred option for end of life care by the care givers. Lack of community-based terminal care support system and availability of analgesics are the main areas to work on in India.
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Affiliation(s)
- Kunal Das
- Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Tanvi Khanna
- Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Anshika Arora
- Division of Palliative Care, Cancer Research Institute, HimalayanInstitute of Medical Sciences, Dehradun, India
| | - Nitika Agrawal
- Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
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Badarau DO, De Clercq E, Elger BS. Continuous Deep Sedation and Euthanasia in Pediatrics: Does One Really Exclude the Other for Terminally Ill Patients? THE JOURNAL OF MEDICINE AND PHILOSOPHY 2019; 44:50-70. [PMID: 30649451 DOI: 10.1093/jmp/jhy033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Debates on morally acceptable and lawful end-of-life (EOL) practices in pediatrics were reignited by the recent amendment in Belgian law to allow euthanasia for minors of any age who meet the criteria for capacity. Euthanasia and its legalization in pediatrics are often opposed based on the availability of aggressive palliative sedation. For terminally ill patients, this type of sedation is often identified as continuous and deep sedation until death (CDS). We demonstrate that this reasoning is based on flawed assumptions: (1) CDS is a morally preferable alternative to euthanasia; (2) CDS can meet the same patient needs as euthanasia; (3) children lack the capacity and experience to make EOL decisions; (4) unlike euthanasia, CDS does not raise capacity issues. Our aim is not to reject CDS as a valid option at the EOL, nor to offer a clear-cut defense of euthanasia for minors, but to emphasize the ethical issues with both practices.
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Chong LA, Chong PH, Chee J. Pharmacological Management of Symptoms in Children with Life-Limiting Conditions at the End of Life in the Asia Pacific. J Palliat Med 2018; 21:1242-1248. [PMID: 29733235 DOI: 10.1089/jpm.2017.0626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The provision of pediatric palliative care in Asia Pacific varies between countries and availability of essential medications for symptoms at the end of life in this region is unclear. OBJECTIVE To determine medications available and used in the management of six symptoms at the end of life among pediatric palliative care practitioners in Asia Pacific. To identify alternative pharmacological strategies for these six symptoms if the oral route was no longer possible and injections are refused. DESIGN AND SETTING An online survey of all Asia Pacific Hospice Palliative Care Network (APHN) members was carried out to identify medications used for six symptoms (pain, dyspnea, excessive respiratory secretions, nausea/vomiting, restlessness, seizures) in dying children. Two scenarios were of interest: (1) hours to days before death and (2) when injectables were declined or refused. RESULTS There were 54 responses from 18 countries. Majority (63.0%) of respondents were hospital based. About half of all respondents were from specialist palliative care services and 55.6% were from high-income countries. All respondents had access to essential analgesics. Several perceived that there were no available drugs locally to treat the five other commonly encountered symptoms. There was a wide variation in preferred drugs for treating each symptom that went beyond differences in drug availability or formulations. CONCLUSION Future studies are needed to explore barriers to medication access and possible knowledge gaps among service providers in the region, so that advocacy and education endeavors by the APHN may be optimized.
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Affiliation(s)
- Lee Ai Chong
- 1 Department of Paediatrics, University of Malaya , Kuala Lumpur, Malaysia
| | | | - Joyce Chee
- 3 Department of Palliative Medicine, Asia Pacific Hospice Palliative Care Network , National Cancer Centre Singapore, Singapore, Singapore
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Darbyshire P, Mischo-Kelling M, Lochner L, Messerschmidt-Grandi C. ‘Fighting for care’: parents' perspectives of children's palliative care in South Tyrol, Italy. Int J Palliat Nurs 2015; 21:542-7. [DOI: 10.12968/ijpn.2015.21.11.542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Maria Mischo-Kelling
- Professor of Nursing, University of Applied Science Ravensburg-Weingarten, Germany
| | - Lukas Lochner
- Medical Tutor, at Claudiana College of Health-Care Professions, Bolzano/Bozen, Italy
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Beecham E, Candy B, Howard R, McCulloch R, Laddie J, Rees H, Vickerstaff V, Bluebond‐Langner M, Jones L. Pharmacological interventions for pain in children and adolescents with life-limiting conditions. Cochrane Database Syst Rev 2015; 2015:CD010750. [PMID: 25768935 PMCID: PMC6481584 DOI: 10.1002/14651858.cd010750.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pain is one of the most common symptoms in children and young people (CYP) with life-limiting conditions (LLCs) which include a wide range of diagnoses including cancer. The current literature indicates that pain is not well managed, however the evidence base to guide clinicians is limited. There is a clear need for evidence from a systematic review to inform prescribing. OBJECTIVES To evaluate the evidence on the effectiveness of different pharmacological interventions used for pain in CYP with LLCs. SEARCH METHODS The following electronic databases were searched up to December 2014: CENTRAL (in the Cochrane Library), MEDLINE, EMBASE, PsycINFO and CINAHL. In addition, we searched conference proceedings and reference lists of included studies. For completeness, we also contacted experts in the field. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-randomised studies and other studies that included a clearly defined comparator group were included. The studies investigated pharmacological treatments for pain associated with LLCs in CYP. The treatment included those specifically developed to treat pain and those that acted as an adjuvant, where the treatment was not primarily developed to treat pain but has pain relieving properties. The LLC was identified by its inclusion in the Richard Hain Directory of LLCs. DATA COLLECTION AND ANALYSIS Citations were screened by five review authors. Data were extracted by one review author and checked by a second. Two review authors assessed the risk of bias of included studies. A sufficient number of studies using homogeneous outcomes was not identified so a meta-analysis was not possible. MAIN RESULTS We identified 24,704 citations from our database search. Nine trials with 379 participants fulfilled our inclusion criteria. Participants had cerebral palsy (CP) in five of the studies and osteogenesis imperfecta (OI) in the other four. Participants across the trials ranged in age from 2 to 19 years. All studies, apart from one cross-over trial, were parallel designed RCTs. Three of the trials on CP evaluated intrathecal baclofen (ITB) and two botulinum toxin A (BoNT-A). All of the OI trials evaluated the use of bisphosphonates (two alendronate and one pamidronate). No trials were identified that evaluated a commonly used analgesic in this patient group. Pain was a secondary outcome in five of the eight identified studies. Overall the quality of the trials was mixed. Only one study involved over 100 participants.For the two ITB studies for pain in CP, in the same study population but assessed at different time points in their disease, both found an effect on pain favouring the intervention compared to the control group (standard care or placebo) (mean difference (MD) 4.20, 95% confidence interval (CI) 2.15 to 6.25; MD 26.60, 95% CI 2.61 to 50.59, respectively). In these studies most of the adverse events related to the procedure or device for administration rather than the drug, such as swelling at the pump site. In one trial there were also eight serious adverse effects; these included difficulty swallowing and an epileptic seizure. The trial did not state if these occurred in the intervention group. At follow-up in both BoNT-A trials there was no evidence of a difference in pain between the trial arms among CP participants. The adverse events in the BoNT-A trials mostly involved those who received the intervention drug and involved seizures. Gastrointestinal problems were the most frequent adverse event in those who received alendronate. The trial investigating pamidronate found no evidence of a difference in pain compared to the control group. No adverse events were reported in this trial. AUTHORS' CONCLUSIONS Published, controlled evidence on the pharmacological interventions for pain in CYP with LLCs is limited. The evidence that is currently available evaluated pain largely as a secondary outcome and the drugs used were all adjuvants and not always commonly used in general paediatric palliative care for pain. Based on current data this systematic review is unable to determine the effects of pharmacological interventions for pain for CYP with LLCs. Future trials with larger populations should examine the effects of the drugs commonly used as analgesics; with the rising prevalence of many LLCs this becomes more necessary.
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Affiliation(s)
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
| | - Richard Howard
- Great Ormond Street HospitalAnaesthesia and Pain ManagementGreat Ormond StreetLondonUKWC1N 3JH
| | - Renée McCulloch
- Great Ormond Street HospitalLouis Dundas Centre for Children's Palliative Care, Palliative Care TeamLondonUK
| | - Jo Laddie
- Evelina London Children's HospitalDepartment of Paediatric Palliative MedicineLondonUK
| | - Henrietta Rees
- UCL Institute of Child HealthLouis Dundas Centre for Children's Palliative CareLondonUK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
| | | | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
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Valadares MTM, Mota JAC, de Oliveira BM. Palliative care in pediatric hematological oncology patients: experience of a tertiary hospital. Rev Bras Hematol Hemoter 2014; 36:403-8. [PMID: 25453649 PMCID: PMC4318475 DOI: 10.1016/j.bjhh.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/25/2014] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the approach to palliative care for hematological oncology patients in the pediatric ward of a tertiary hospital. Methods This was a retrospective, descriptive study of 29 hematological oncology patients who died between 2009 and 2011. Data regarding the approach and prevalence of pain, prevalence of other symptoms, multidisciplinary team participation, communication between staff and family and limited invasive therapy were collected from the medical records. Results Twenty-seven (93.1%) patients displayed disease progression unresponsive to curative treatment. The median age at death was ten years old. Pain was the most prevalent symptom with all patients who reported pain receiving analgesic medications. The majority took weak (55.2%) and/or strong (65.5%) opioids. The patients were followed by pediatricians and a pediatric hematologist/oncologist. Participation of other professionals was also documented: 86.2% were followed by social services and 69% by psychologists, among others. There were explicit descriptions of limitation of invasive therapy in the medical records of 26 patients who died with disease progression. All these decisions were shared with the families. Conclusion Although the hospital where this study was conducted does not have a specialized team in pediatric palliative care, it meets all the requirements for developing a specific program. The importance of approaching pain and other prevalent symptoms in children with cancer involving a comprehensive multidisciplinary team is evident. Discussions were had with most of the families on limiting invasive therapy, but no record of a well-defined and coordinated treatment plan for palliative care was found.
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Park JD, Kang HJ, Kim YA, Jo M, Lee ES, Shin HY, Yun YH. Trends in the aggressiveness of end-of-life care for Korean pediatric cancer patients who died in 2007-2010. PLoS One 2014; 9:e99888. [PMID: 24923320 PMCID: PMC4055703 DOI: 10.1371/journal.pone.0099888] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 05/20/2014] [Indexed: 11/18/2022] Open
Abstract
Background In light of the Korean Supreme Court's 2009 ruling favoring a patient's right to die with dignity, we evaluated trends in aggressive care in a cohort of pediatric cancer patients. Methods We conducted a population-based retrospective study that used administrative data for patients who died in 2007–2010 among the 5,203 pediatric cancer patients registered at the Korean Cancer Central Registry (KCCR) during 2007–2009. Results In the time period covered, 696 patients died. The proportion who had received chemotherapy in the last 30 days of life decreased from 58.1% to 28.9% (P<0.001), those who received new chemotherapy in the same time period decreased from 55.2% to 15.1% (P<0.001), and those who received treatment in the last 2 weeks of life decreased from 51.4% to 21.7% (P<0.001). In the last 30 days of life, the proportion of patients whose hospital admission period was over 14 days increased from 70.5% to 82.5% (P = 0.03), the proportion who received cardiopulmonary resuscitation decreased from 28.6% to 9.6% (P<0.001), and we found no statistically significant trends in the proportion of emergency department visits, intensive care unit admissions, or mechanical ventilation. Conclusions In this study, in contrast with earlier ones, the aggressiveness of end-of-life care of Korean pediatric cancer patients decreased dramatically.
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Affiliation(s)
- June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Cancer Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ae Kim
- Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - MinKyoung Jo
- Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Eun Sook Lee
- Hospital and Research Institute, National Cancer Center, Goyang, Korea
| | - Hee Young Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Cancer Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Yun
- Cancer Institute, Seoul National University College of Medicine, Seoul, Korea
- Departmentof Biomedical Science, Seoul National University Hospital and College of Medicine, Seoul, Korea
- * E-mail:
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Beecham E, Howard R, McCulloch R, Candy B, Laddie J, Rees H, Vickerstaff V, Bluebond-Langner M, Jones L. Pharmacological interventions for pain for life-limiting conditions in children and adolescents. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Van Cleve L, Muñoz CE, Riggs ML, Bava L, Savedra M. Pain experience in children with advanced cancer. J Pediatr Oncol Nurs 2012; 29:28-36. [PMID: 22367767 DOI: 10.1177/1043454211432295] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is important for health care professionals to understand the pain experience in children with advanced cancer. There has been increased attention to this topic, but systematic studies are limited. OBJECTIVE To examine pain symptoms and management in children with advanced cancer using child self-report and nurse documentation. METHODS A prospective, longitudinal method was used to collect data from 62 children over a 5-month period. Children were English and Spanish speaking, ages 6 to 17 years, with advanced cancer. Nurses also provided data. RESULTS Across all interviews, pain was reported 56% of the time by all children. Nurses documented pain only 23% of the time. Children most frequently reported head pain (31%), followed by abdomen, lower back, leg, and feet pain (20% to 30%). Children consistently reported more intense pain compared with nurses. Nonopioids were used more frequently (45%) than opioids (32%), and nurses' perception of pain intensity was more highly correlated with administration of opioids (r = .72, P < .001). Children who died during their participation in this study received more opioids over time. Pain intensity was relatively stable over time. Nurses noted ethnicity related differences with higher pain levels for Caucasian children, who received analgesics more frequently. DISCUSSION The children consistently reported pain. Child self-report and nurse documentation of pain differed, as did pain management among children who died compared with those who did not. Ethnicity differences in the identification and management of pain by nurses begs further study. Overall, nurses were aware of and responsive to pain and pain management.
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Knapp C, Woodworth L, Wright M, Downing J, Drake R, Fowler-Kerry S, Hain R, Marston J. Pediatric palliative care provision around the world: a systematic review. Pediatr Blood Cancer 2011; 57:361-8. [PMID: 21416582 DOI: 10.1002/pbc.23100] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 01/27/2011] [Indexed: 11/05/2022]
Abstract
Pediatric palliative care is recommended by many organizations. Yet, there is no information available on the progress that has been made in providing this care or the gaps that still exist in provision around the world. We conducted a systematic review to address this gap in knowledge. The systematic review identified 117 peer-reviewed and non-peer reviewed resources. Based on this information, each country was assigned a level of provision; 65.6% of countries had no known activities, 18.8% had capacity building activities, 9.9% had localized provision, and 5.7% had provision that was reaching mainstream providers. Understanding the geographic distribution in the level of provision is crucial for policy makers and funders.
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Affiliation(s)
- Caprice Knapp
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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