Dana-Farber Cancer Institute, Boston, MA, USA.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
J Pediatr Oncol Nurs. 2020 Jul/Aug;37(4):284-295. doi: 10.1177/1043454220909805. Epub 2020 Mar 10.
Children with cancer experience multiple symptoms at end of life (EOL) that impair their health-related quality of life. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, this integrative literature review comprehensively summarized symptom experiences of children with cancer at EOL. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Academic Premier were searched between January 2007 to September 2019 for articles published in English using the MeSH terms: symptom burden or distress AND children with cancer or pediatric cancer or cancer children or oncology and pediatrics AND EOL care or palliative care or death or dying or terminally ill. The inclusion criteria were the following: (a) study designs [randomized controlled trials, nonexperimental, secondary analysis (if aims were distinct from primary studies) and qualitative]; (b) participants <18 years old (died of cancer, had no realistic chance of cure, or had advanced cancer); and (c) focused on symptom experiences/burden at EOL. Exclusion criteria were nonresearch articles, systematic reviews, case studies, reports, and studies that focused on cancer survivors and/or those receiving curative therapies. Twenty-seven articles met inclusion criteria. The most prevalent symptoms-pain, fatigue, dyspnea, and loss of appetitewere associated with impairments in health-related quality of life. Children with brain tumors experienced higher symptom burden compared to those with hematologic/solid malignancies. Children who received cancer-directed therapies experienced disproportionate symptoms and were more likely to die in the intensive care unit compared with those who did not receive cancer-directed therapies. Most common location of death was home. This integrative review indicated that children with cancer were polysymptomatic at EOL. Strategies facilitating effective symptom management at EOL are needed.
患有癌症的儿童在生命末期 (EOL) 会经历多种症状，这些症状会损害他们的健康相关生活质量。本综述使用系统评价和荟萃分析的首选报告项目指南，全面总结了患有癌症的儿童在 EOL 时的症状体验。在 2007 年 1 月至 2019 年 9 月期间，使用 MeSH 术语在 Cumulative Index to Nursing and Allied Health Literature (CINAHL)、PubMed 和 Academic Premier 中搜索了以英文发表的文章，术语为：症状负担或痛苦和儿童癌症或儿科癌症或癌症儿童或肿瘤学和儿科学和 EOL 护理或姑息治疗或死亡或临终或绝症。纳入标准如下：(a)研究设计 [随机对照试验、非实验性、二次分析（如果目的与主要研究不同）和定性]；(b)参与者<18 岁（死于癌症，没有现实治愈机会，或患有晚期癌症）；(c)专注于 EOL 时的症状体验/负担。排除标准为非研究文章、系统评价、案例研究、报告以及关注癌症幸存者和/或接受治愈性治疗的研究。有 27 篇文章符合纳入标准。最常见的症状——疼痛、疲劳、呼吸困难和食欲不振——与健康相关生活质量受损有关。与血液/实体恶性肿瘤相比，患有脑肿瘤的儿童经历了更高的症状负担。接受癌症定向治疗的儿童经历了不成比例的症状，并且与未接受癌症定向治疗的儿童相比，更有可能在重症监护病房死亡。最常见的死亡地点是家。本综合综述表明，患有癌症的儿童在 EOL 时表现出多种症状。需要制定策略来促进 EOL 时的有效症状管理。
