End-of-life care for pediatric cancer patients

Cancer is the leading disease that causes death to children ages 1 to 19. Over the last decades, the treatment of pain and the quality of end-of-life (EOL) care for children with cancer has improved. However, a lot of work still needs to be done to make it more effective. Children with terminal cancer normally receive pain medications but many parents have reported that their dying children suffering from pain in the last few days of their lives. Attending physicians and nurses also admitted that they have difficulties in pain management. A study which interviewed parents also revealed that pediatric oncologists may need to further improve their pain management skills.

 Opioids are a class of drugs commonly prescribed to young cancer patients in hospitals to relieve them from pain during their last week of life. This latest findings of a study, however, showed that treatments of opioids greatly vary among hospitals. The investigators examined the cases of 1,466 patients ages 24 or younger using the data from the Pediatric Health Information System. The patients were treated at 33 hospitals at the time of death from 2001 to 2005. The results showed that only 56% of the patients have received daily therapy of opioids during the hospital stay of their last week of life. The daily opioid therapy varied significantly among children’s hospital ranging from 0 to 90.5% of the eligible patients. Sixty-four percent of the patients with private insurance received opioids daily, while only 52% of those with Medicaid or other government coverage received the drug. Patients aged 10-19 also received more opioid treatments (61%) compared to the younger or older patients. Furthermore, patients with brain tumors received lesser opioid therapies compared to those with other types of cancer such as leukemia or lymphoma.

 The manner in which opioids are used in palliative care within a hospital may be due to several factors. Regardless of the reasons, the variation of pediatric EOL care practices among hospitals suggests that changes in EOL care practices would be most effective if they are adapted to the specific configuration of each hospital which would take into consideration the social, cultural, technical and institutional factors.

 According to Dr. Andrea D. Orsey co-author of the study:

“The findings demonstrate how useful it would be to have indicators to measure the quality of pediatric end-of-life care and enable comparisons across hospitals. Interventions to improve practices in pediatric end-of-life care may be most effective if adapted individually to each hospital”.

Dr. Sarah Friebert, another reseacher on the subject adds:

“Good pain management seems to be the least we can do for our pediatric patients with cancer. Importantly, for those for whom the journey of cancer will not end in cure, relief of distress from pain at the end of life carries long-lasting implications for bereaved parents, who cope much better when their dying children’s pain is well controlled”.