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Symptoms and Suffering at the End of Life in Children with Cancer

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Joanne Wolfe, Holcombe E. Grier, Neil Klar, et al.
Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 1, 2001

Reviewers: Li Liu, MD
Source: The New England Journal of Medicine, volume 342, 326-333, (February) 2000

Introduction

Over the past 30 years, cure rates have increased dramatically for a number of pediatric malignancies because of scientific and technological advances, the advent of specialized pediatric cancer centers for treatment, and the efforts of cooperative group studies. However, improvements in the management of care at the end of life in children with cancer have not kept pace with these clinical advances directed at a cure. In this study, the researchers reported the results of a survey of parents of children who had died of cancer between 1990 and 1997.

Materials and Methods

A total of 103 parents of children who had died from cancer were interviewed and the medical records were reviewed.

Results

• 79% of the children died of their advancing disease, whereas 21% died from treatment-related complications.
• 89% of the children experienced a lot or a great deal of suffering from at least one symptom, and 51% from three or more symptoms.
• Only 76% of the children received treatments for their pain, and these treatments were successful for less than 30% of the children.

Discussion

During their last month of life, most children with cancer suffered a great deal from symptoms that might be relieved by simple treatments. The push for a cure should not eliminate the attention of controlling symptoms, some of which may be induced by aggressive treatment. A multidisciplinary approach may be best. This should be flexible enough to provide support of both children whose disease can be cured and those for whom a cure is not yet possible.