Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee.
Pediatr Blood Cancer. 2018 Apr;65(4). doi: 10.1002/pbc.26895. Epub 2017 Dec 8.
The field of pediatric palliative oncology is newly emerging. Little is known about the characteristics and illness experiences of children with cancer who receive palliative care (PC).
A retrospective cohort study of 321 pediatric oncology patients enrolled in PC who died between 2011 and 2015 was conducted at a large academic pediatric cancer center using a comprehensive standardized data extraction tool.
The majority of pediatric palliative oncology patients received experimental therapy (79.4%), with 40.5% enrolled on a phase I trial. Approximately one-third received cancer-directed therapy during the last month of life (35.5%). More than half had at least one intensive care unit hospitalization (51.4%), with this subset demonstrating considerable exposure to mechanical ventilation (44.8%), invasive procedures (20%), and cardiopulmonary resuscitation (12.1%). Of the 122 patients who died in the hospital, 44.3% died in the intensive care unit. Patients with late PC involvement occurring less than 30 days before death had higher odds of dying in the intensive care unit over the home/hospice setting compared to those with earlier PC involvement (OR: 4.7, 95% CI: 2.47-8.97, P < 0.0001).
Children with cancer who receive PC experience a high burden of intensive treatments and often die in inpatient intensive care settings. Delayed PC involvement is associated with increased odds of dying in the intensive care unit. Prospective investigation of early PC involvement in children with high-risk cancer is needed to better understand potential impacts on cost-effectiveness, quality of life, and delivery of goal concordant care.
儿科姑息肿瘤学领域是一个新兴领域。目前对于接受姑息治疗（PC）的癌症儿童的特点和疾病体验知之甚少。
对 2011 年至 2015 年间在一家大型学术儿科癌症中心接受 PC 并死亡的 321 名儿科肿瘤患者进行了回顾性队列研究，使用了全面的标准化数据提取工具。
大多数儿科姑息肿瘤患者接受了实验性治疗（79.4%），其中 40.5%的患者参加了 I 期试验。大约三分之一的患者在生命的最后一个月接受了癌症定向治疗（35.5%）。超过一半的患者至少有一次 ICU 住院（51.4%），其中这一部分患者接受了相当多的机械通气（44.8%）、侵入性操作（20%）和心肺复苏（12.1%）。在 122 名在医院死亡的患者中，44.3%的患者在 ICU 死亡。与早期 PC 介入相比，PC 晚期介入发生在死亡前 30 天内的患者 ICU 死亡率更高（OR：4.7，95%CI：2.47-8.97，P<0.0001）。
接受 PC 的癌症儿童经历了高强度治疗的高负担，并且经常在住院 ICU 环境中死亡。PC 介入延迟与 ICU 死亡率增加相关。需要前瞻性调查高危癌症儿童的早期 PC 介入，以更好地了解对成本效益、生活质量和目标一致护理的潜在影响。
