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Transition to noncurative end‐of‐life care in paediatric oncology – a nationwide follow‐up in Sweden
Author(s) -
Jalmsell Li,
Forslund Martin,
Hansson Mats G,
Henter JanInge,
Kreicbergs Ulrika,
Frost BrittMarie
Publication year - 2013
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.12242
Subject(s) - medicine , malignancy , pediatrics , medical record , end of life care , retrospective cohort study , relative risk , palliative care , cause of death , confidence interval , disease , nursing
Aim To estimate whether and when children dying from a malignancy are recognized as being beyond cure and to study patterns of care the last weeks of life. Methods A nationwide retrospective medical record review was conducted. Medical records of 95 children (60% of eligible children) who died from a malignancy 2007–2009 in Sweden were studied. Results Eighty‐three children (87%) were treated without curative intent at the time of death. Children with haematological malignancies were less likely to be recognized as being beyond cure than children with brain tumours [relative risks ( RR ) 0.7; 95% confidence interval ( CI ) 0.6–0.9] or solid tumours ( RR 0.8; 0.6–1.0). The transition to noncurative care varied from the last day of life to over four years prior to death (median 60 days). Children with haematological malignancies were treated with a curative intent closer to death and were also given chemotherapy ( RR 5.5; 1.3–22.9), transfusions ( RR 2.0; 1.0–4.0) and antibiotics ( RR 5.3; 1.8–15.5) more frequently than children with brain tumours the last weeks of life. Conclusion The majority of children dying from a malignancy were treated with noncurative intent at the time of death. The timing of a transition in care varied with the diagnoses, being closer to death in children with haematological malignancies.