Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomes
Abstract Background In 2020, the Global Cancer Observatory reported 280,000 cases of childhood cancer worldwide, with a higher burden of disease and mortality rates in low- and middle-income countries. In 2022, the National Institute of Health reported 1708 new cases of childhood cancer in Colombia...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12904-024-01354-1 |
| _version_ | 1797272860988801024 |
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| author | María Isabel Cuervo-Suarez Daniela Cleves Natalia Duque-Nieto Angélica Claros-Hulbert Karen Molina-Gómez Jhon Edwar Bolaños-Lopez María Elena Tello-Cajiao Justin N Baker Michael J. McNeil Ximena García-Quintero |
| author_facet | María Isabel Cuervo-Suarez Daniela Cleves Natalia Duque-Nieto Angélica Claros-Hulbert Karen Molina-Gómez Jhon Edwar Bolaños-Lopez María Elena Tello-Cajiao Justin N Baker Michael J. McNeil Ximena García-Quintero |
| author_sort | María Isabel Cuervo-Suarez |
| collection | DOAJ |
| description | Abstract Background In 2020, the Global Cancer Observatory reported 280,000 cases of childhood cancer worldwide, with a higher burden of disease and mortality rates in low- and middle-income countries. In 2022, the National Institute of Health reported 1708 new cases of childhood cancer in Colombia and an overall survival rate of approximately 55%. The aim of this study is to compare outcomes in children with cancer in the hospital setting during the last 72 h of life who received concurrent Pediatric Palliative Care (PPC) versus oncology care alone. Methods An observational descriptive study was conducted between January 2013 and June 2022 in a center for pediatric patients with oncological diagnoses. In 2017, the PPC team was created. Patients between 28 days and 17 years of age who were hospitalized at least 72 h before death were included. A retrospective review of the medical records of patients in the last 72 h of life was performed. Two cohorts were established: oncology-alone group received exclusive management by oncology, and oncology and PPC received concurrent oncology and PPC management since the diagnosis. Results We evaluated 257 medical records of deceased pediatric patients with cancer diagnoses. For the first cohort (2013–2017), 136 patients were included; for the second cohort (2018 and 2022), 121 patients were evaluated. The most frequent diagnosis was leukemia [47.1% (n = 121)]. No significant difference was found in either group between dyspnea, pain, and seizures. Dyspnea was the most frequent symptom in both groups. Agitation and anxiety were reported more frequently in children from the oncology-alone group (22.1% and 13.2%, respectively). The oncology and PPC group received more psychology and social work consultation (94.2% and 70.2% vs. 84.6 and 54.4% in the oncology alone group) and had a higher percentage of advance care planning (79.3% vs. 62.5% in the oncology alone group). Conclusions This retrospective study highlights that PPC at the end of life (EoL) offers a holistic approach to the physical and psychosocial symptoms experienced by children with cancer; these patients received more comfort through symptom management and less aggressive treatment at the EoL. The availability of a PPC team may contribute to improvements in the quality of end-of-life care. Trial registration retrospectively registered. |
| first_indexed | 2024-03-07T14:34:52Z |
| format | Article |
| id | doaj.art-ec75719eedc241fbb7d980e7cb7d9f21 |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-03-07T14:34:52Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-ec75719eedc241fbb7d980e7cb7d9f212024-03-05T20:42:55ZengBMCBMC Palliative Care1472-684X2024-02-012311910.1186/s12904-024-01354-1Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomesMaría Isabel Cuervo-Suarez0Daniela Cleves1Natalia Duque-Nieto2Angélica Claros-Hulbert3Karen Molina-Gómez4Jhon Edwar Bolaños-Lopez5María Elena Tello-Cajiao6Justin N Baker7Michael J. McNeil8Ximena García-Quintero9Palliative Care Department, Fundación Valle del LiliDepartment of Global Pediatric Medicine, St. Jude Children’s HospitalDepartment of Pain and Palliative Care, Grupo Keralty, Clinica Sebastian de BelalcazarFaculty of Health Sciences, Universidad de la SabanaPalliative Care Department, Fundación Valle del LiliCentro de Biociencias, Seguros SURA ColombiaFacultad de Ciencias de la Salud, Universidad IcesiDivision Chief, Quality of Life and Pediatric Palliative, Stanford University School of MedicineDepartment of Global Pediatric Medicine, St. Jude Children’s HospitalDepartment of Global Pediatric Medicine, St. Jude Children’s HospitalAbstract Background In 2020, the Global Cancer Observatory reported 280,000 cases of childhood cancer worldwide, with a higher burden of disease and mortality rates in low- and middle-income countries. In 2022, the National Institute of Health reported 1708 new cases of childhood cancer in Colombia and an overall survival rate of approximately 55%. The aim of this study is to compare outcomes in children with cancer in the hospital setting during the last 72 h of life who received concurrent Pediatric Palliative Care (PPC) versus oncology care alone. Methods An observational descriptive study was conducted between January 2013 and June 2022 in a center for pediatric patients with oncological diagnoses. In 2017, the PPC team was created. Patients between 28 days and 17 years of age who were hospitalized at least 72 h before death were included. A retrospective review of the medical records of patients in the last 72 h of life was performed. Two cohorts were established: oncology-alone group received exclusive management by oncology, and oncology and PPC received concurrent oncology and PPC management since the diagnosis. Results We evaluated 257 medical records of deceased pediatric patients with cancer diagnoses. For the first cohort (2013–2017), 136 patients were included; for the second cohort (2018 and 2022), 121 patients were evaluated. The most frequent diagnosis was leukemia [47.1% (n = 121)]. No significant difference was found in either group between dyspnea, pain, and seizures. Dyspnea was the most frequent symptom in both groups. Agitation and anxiety were reported more frequently in children from the oncology-alone group (22.1% and 13.2%, respectively). The oncology and PPC group received more psychology and social work consultation (94.2% and 70.2% vs. 84.6 and 54.4% in the oncology alone group) and had a higher percentage of advance care planning (79.3% vs. 62.5% in the oncology alone group). Conclusions This retrospective study highlights that PPC at the end of life (EoL) offers a holistic approach to the physical and psychosocial symptoms experienced by children with cancer; these patients received more comfort through symptom management and less aggressive treatment at the EoL. The availability of a PPC team may contribute to improvements in the quality of end-of-life care. Trial registration retrospectively registered.https://doi.org/10.1186/s12904-024-01354-1Palliative CareCancer Care UnitsPediatricsEnd-Of-Life Care |
| spellingShingle | María Isabel Cuervo-Suarez Daniela Cleves Natalia Duque-Nieto Angélica Claros-Hulbert Karen Molina-Gómez Jhon Edwar Bolaños-Lopez María Elena Tello-Cajiao Justin N Baker Michael J. McNeil Ximena García-Quintero Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomes BMC Palliative Care Palliative Care Cancer Care Units Pediatrics End-Of-Life Care |
| title | Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomes |
| title_full | Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomes |
| title_fullStr | Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomes |
| title_full_unstemmed | Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomes |
| title_short | Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomes |
| title_sort | children with cancer at the end of life in a middle income country integrated pediatric palliative care improves outcomes |
| topic | Palliative Care Cancer Care Units Pediatrics End-Of-Life Care |
| url | https://doi.org/10.1186/s12904-024-01354-1 |
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