Better care eases suffering of kids with cancer
By Will Boggs, MD
NEW YORK (Reuters Health) - Increasing attention to palliative care has reduced suffering for children with cancer in recent years, according to a new report.
"When we first published our original study in 2000, I think there was a more passive approach to caring for children with cancer at the end of life," Dr. Joanne Wolfe from the Dana-Farber Cancer Institute, Boston, told Reuters Health. "In our current study, we have shown that through an active and intensive focus on the needs of children with advanced cancer and their families, care can be improved upon."
Wolfe and her colleagues determined whether efforts to improve communication, symptoms, and quality of life in children with advanced cancer have changed patterns of care for children at the end of life.
The researchers reviewed the medical records of 119 children treated at Dana-Farber or Children's Hospital and who died of cancer between 1997 and 2004.
From the 1990s to the early 2000s, there was a 22 percentage point increase in the documentation of discussion about hospice care, the authors report in the Journal of Clinical Oncology. Furthermore, hospice discussions and do-not-resuscitate orders were documented earlier in the course of care.
Parents reported no difference in the proportion of children who experienced fatigue, pain, breathing difficulty, or anxiety between the earlier and later periods, the researchers note, but reports of "a great deal" or "a lot" of suffering decreased in the later period for all symptoms except fatigue.
Moreover, a significantly greater proportion of parents in the later period felt "very prepared" for the medical problems experienced by their child at the end of life and for the circumstances at the time of death.
"Our results suggest that increased focus on the palliative care needs of children with advanced cancer and their families creates an environment that fosters significantly improved end-of-life care, with parents reporting better preparedness for the end-of-life course and decreased suffering in their children," the investigators conclude.
"This finding is really important in the sense that it suggests that child and family suffering can be further eased, especially with more targeted interventions," Wolfe added.
SOURCE: Journal of Clinical Oncology, April 1, 2008.