Department of Pediatrics, Emory University, Atlanta, Georgia.
Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia.
Pediatr Blood Cancer. 2020 Oct;67(10):e28363. doi: 10.1002/pbc.28363. Epub 2020 Jul 24.
Pediatric patients with sarcomas experience significant morbidity and compromised quality of life throughout their course. These times could be viewed as opportunities for increased subspecialty palliative care (PC). Systematically defining opportunities for additional PC support has not occurred in pediatric oncology. The frequency, timing, and associated factors for palliative opportunities in pediatric patients with sarcomas are unknown.
A priori, nine palliative opportunities were defined (disease progression or relapse, admission for symptoms, social concerns or end-of-life, intensive care or bone marrow transplant admission, phase 1 trial or hospice enrollment, do-not-resuscitate status). A single-center retrospective review was conducted on patients aged 0-18 years with bone/soft tissue sarcomas who died from January 1, 2012 to November 30, 2017. Demographic, disease, and treatment data were collected. Descriptive statistics were performed. Opportunities were evaluated over quartiles from diagnosis to death.
Patients (n = 60) had a mean of nine (SD = 4) palliative opportunities with the majority occurring in the last quartile of the disease course. Number and type of opportunities did not differ by demographics or diagnosis. Eighteen patients (30%) received PC consultation a median of 2.2 months (interquartile range [IQR] 11.5) prior to death. Consultation was unrelated to diagnosis or total opportunities.
Patients with sarcomas incur repeated events warranting subspecialty PC, which increase toward the end-of-life. Increased PC utilization may help decrease suffering and bolster family coping during these episodes. Additional work should further refine if opportunities differ across cancers, and how to incorporate this framework into clinical oncology care to prevent missed opportunities for PC.
患有肉瘤的儿科患者在整个病程中都会经历严重的发病率和生活质量受损。这些时期可以被视为增加儿科姑息治疗（PC）的机会。在儿科肿瘤学中，尚未系统地确定额外 PC 支持的机会。肉瘤儿科患者的姑息机会的频率、时间和相关因素尚不清楚。
首先定义了九个姑息机会（疾病进展或复发、因症状入院、社会问题或临终关怀、重症监护或骨髓移植入院、1 期试验或临终关怀入院、不复苏状态）。对 2012 年 1 月 1 日至 2017 年 11 月 30 日期间因骨/软组织肉瘤死亡的 0-18 岁患者进行了单中心回顾性研究。收集了人口统计学、疾病和治疗数据。进行了描述性统计。机会是在从诊断到死亡的四分位数上进行评估的。
患者（n=60）平均有 9 次（SD=4）姑息机会，其中大多数发生在疾病过程的最后一个四分位数。机会的数量和类型与人口统计学或诊断无关。18 名患者（30%）在死亡前中位数 2.2 个月（四分位距 [IQR] 11.5）接受了姑息治疗咨询。咨询与诊断或总机会无关。
肉瘤患者会经历反复的事件，需要专科姑息治疗，这些事件会在生命末期增加。增加姑息治疗的使用可能有助于减少这些事件中的痛苦，并增强家庭应对能力。还需要进一步研究机会是否因癌症而异，以及如何将这一框架纳入临床肿瘤学护理，以防止姑息治疗机会被错过。
