Navigation Links
Study finds improvement in the care of children with cancer at the end of life
Date:3/28/2008

BOSTON--Expanded use of palliative care services is associated with enhanced communications between families and caregivers, improved symptoms management, and better quality of life for children dying from cancer, according to study by researchers at Dana-Farber Cancer Institute and Children's Hospital Boston.

Published in the April 1 issue of the Journal of Clinical Oncology, the study's findings also suggest that the parents were more likely to feel they were prepared for their children's end-of-life medical problems.

"Historically, there has been resistance to palliative care and hospice care in the United States, in part because some people feel that using these services is associated with hopelessness and giving up," said lead author Joanne Wolfe, MD, MPH, director of Pediatric Palliative Care at Dana-Farber and Children's Hospital. "This is changing, however, as more people -- caregivers, patients and families alike -- become more familiar with the goal of these services, which is to help each patient live the best possible life."

The retrospective study involved surveying parents and reviewing the medical records of 119 children cared for at Dana-Farber or Children's Hospital and who died from cancer between 1997 and 2004. These data were compared with the findings from a similar parent survey and medical records review of 102 Dana-Farber and Children's cancer patients who died between 1990 and 1997. The study's goal was to determine whether greater focus on palliative care on the local and national levels would affect patterns of care, care planning and patients quality of life.

Wolfe and her colleagues identified notable changes in the patterns of care. Medical record reviews indicated a 40.7 percent increase in documented discussions about home or hospice care in the follow-up study (76 percent of medical records included a note that palliative care options were discussed with the family, up from 54 percent). There also was a 16.4 percent increase in do-not-resuscitate orders (78 percent, up from 67 percent). The proportion of children who died at home remained similar between the two studies, but, in the second study, there was a 42.1 percent decrease in the proportion of the children who died in the intensive care unit (22 percent, down from 38 percent).

Although the follow-up study indicated that children were proportionately as likely to experience fatigue, pain, shortness of breath, or anxiety, they suffered less from the symptoms, with the exception of fatigue.

Wolfe said that one of the most meaningful findings to her was the shift in where children are dying. "Fewer children are dying in the intensive care unit, and that is likely because other options are open to families," explained Wolfe. "This might be because there are more opportunities to have conversations around this intensely sad outcome, but at least it is making a bit of a difference in the context of losing a child to an illness. Dying in the ICU might be the right location for some children and families, but at least they are aware that they have options."

Results from the baseline study, reported by Wolfe and her colleagues in the New England Journal of Medicine in 2000, indicated that children who died from cancer at Dana-Farber or Children's Hospital received aggressive treatment at end of life, many experienced substantial suffering, and efforts to control symptoms were often unsuccessful.

Though it was difficult to share the two institutions' data publicly, Wolfe said it was clear that the majority of hospitals in the U.S. were lacking significantly in the field of pediatric palliative care. She now appreciates that the study served as a call to action for many hospitals, including Dana-Farber and Children's Hospital.

The findings from the first study prompted caregivers and administrators at Dana-Farber and Childrens to identify ways to improve care for children with life-threatening illnesses and their families. This led to the establishment of the pediatric advanced care team (PACT) in 1997. PACT's primary goal is to help children live as well as possible for as long as possible.

PACT utilizes several strategies to improve the care of children and their families, including holding a monthly multidisciplinary case-based conference to educate caregivers about palliative care; providing clinical consultations to caregivers and patients and their families in the inpatient, outpatient and home settings; and developing system-wide improvements to promote consistent, though flexible, care. For example, they worked to change hospital policy so that children dying with cancer can be admitted directly to the oncology inpatient unit rather than require them to be seen in the emergency room before being admitted.


'/>"/>

Contact: Bill Schaller
william_schaller@dfci.harvard.edu
617-632-5357
Dana-Farber Cancer Institute
Source:Eurekalert

Related medicine news :

1. Positive results from Visudyne(R) combination therapy study reported at Annual Macula Society Conference
2. Family Study Associates Pesticide Use With Parkinsons Risk
3. Study finds widespread care disparities in Medi-Cal program
4. Once-Daily Insulin Shot Proves Effective in Study
5. IPods Dont Interfere With Pacemakers, Study Shows
6. Yale study shows weight bias is as prevalent as racial discrimination
7. Meditation Can Wish You Well, Study Says
8. U of M Study Provides First Scientific Evidence That the Freedom to Breathe Act is Creating Healthier Workplaces for Hospitality Employees
9. Kaiser Permanente Study Shows That a Larger Abdomen in Midlife Increases Risk of Dementia
10. Teen Driving Experts at The Childrens Hospital of Philadelphia Support New Recommendations From the New Jersey Teen Driver Study Commission
11. Best Practice Database: Complimentary Excerpt of Scientific Publications Strategy Study
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:12/8/2016)... ... December 08, 2016 , ... Premier Fitness Camp (PFC) and The Chopra Center ... loss and wellness program, at their world headquarters of Omni La Costa Resort & ... results to anyone seeking weight loss, personal development, a healthy lifestyle, or mental and ...
(Date:12/8/2016)... ... December 08, 2016 , ... STAT courier is pleased ... a convenient service for Texas, they are expanding their presence in Dallas. One of ... spree that will bring new jobs to the Dallas and Forth Worth market. STAT ...
(Date:12/8/2016)... ... December 08, 2016 , ... ... planning services from offices headquartered in Little Rock, has initiated a charity drive ... to the National Foundation to End Senior Hunger, Arkansas ranks first in senior ...
(Date:12/8/2016)... ... December 08, 2016 , ... The Compretta Insurance Agency, a family ... in and around the Hancock County area, is announcing the launch of a charity ... , The Hancock County Food Pantry has worked for more than 30 years to ...
(Date:12/7/2016)... ... December 07, 2016 , ... "Today, MHA and ... comprehensive mental health systems reform legislation in more than fifty years. We applaud ... commitment of our elected officials to improving mental health services and supports in ...
Breaking Medicine News(10 mins):
(Date:12/8/2016)... , December 8, 2016 ... Excipients Market by Product (Actual Sugars, Sugar Alcohols, ... & Diluent, Tonicity Agents), Formulation (Oral, Topical, Parenteral) ... the market has witnessed healthy growth during the ... a CAGR of 4.3% between 2016 and 2021 ...
(Date:12/8/2016)... , December 8, 2016 According to a ... Pulse, BP, Sleep, Fetal), Therapeutic (Pain, Insulin)), End Use (Sports, Fitness, RPM), ... published by MarketsandMarkets, the global market, in terms of value, is projected ... at a CAGR of 18.0% during the forecast period. ... ...
(Date:12/8/2016)... ANGELES , Dec. 8, 2016  Hanson ... manufacturing of dissolution testing and diffusion testing instruments ... been acquired by Teledyne Instruments, Inc. ("Teledyne"). The ... long-proven line of precision testing instruments, as well ... accelerating development of new products and services. ...
Breaking Medicine Technology: