Division of Pediatric Hematology and Oncology, Vall d'Hebrón Hospital, Pg. de La Vall d'Hebron, 119, 08035, Barcelona, Spain.
Palliative Care and Complex Chronic Patient Service, Sant Joan de Déu Hospital, Barcelona, Spain.
Clin Transl Oncol. 2024 Mar;26(3):786-795. doi: 10.1007/s12094-023-03301-7. Epub 2023 Aug 30.
Brain tumors represent the most common cause of cancer-related death in children. Few studies concerning the palliative phase in children with brain tumors are available.
(i) To describe the palliative phase in children with brain tumors; (ii) to determine whether the use of palliative sedation (PS) depends on the place of death, the age of the patient, or if they received specific palliative care (PC).
Retrospective multicenter study between 2010 and 2021, including children from one month to 18 years, who had died of a brain tumor.
228 patients (59.2% male) from 10 Spanish institutions were included. Median age at diagnosis was 5 years (IQR 2-9) and median age at death was 7 years (IQR 4-11). The most frequent tumors were medulloblastoma (25.4%) and diffuse intrinsic pontine glioma (DIPG) (24.1%). Median number of antineoplastic regimens were 2 (range 0-5 regimens). During palliative phase, 52.2% of the patients were attended by PC teams, while 47.8% were cared exclusively by pediatric oncology teams. Most common concerns included motor deficit (93.4%) and asthenia (87.5%) and communication disorders (89.8%). Most frequently prescribed supportive drugs were antiemetics (83.6%), opioids (81.6%), and dexamethasone (78.5%). PS was administered to 48.7% patients. Most of them died in the hospital (85.6%), while patients who died at home required PS less frequently (14.4%) (p = .01).
Children dying from CNS tumors have specific needs during palliative phase. The optimal indication of PS depended on the center experience although, in our series, it was also influenced by the place of death.
脑肿瘤是儿童癌症相关死亡的最常见原因。关于脑肿瘤患儿姑息治疗阶段的研究很少。
（一）描述脑肿瘤患儿的姑息治疗阶段；（二）确定姑息镇静（PS）的使用是否取决于死亡地点、患者年龄，或者是否接受了特定的姑息治疗（PC）。
这是一项回顾性多中心研究，纳入了 2010 年至 2021 年期间来自西班牙 10 家机构的一个月至 18 岁因脑肿瘤死亡的患儿。
纳入了 228 名患儿（59.2%为男性），来自 10 家西班牙机构。诊断时的中位年龄为 5 岁（IQR 2-9），死亡时的中位年龄为 7 岁（IQR 4-11）。最常见的肿瘤是髓母细胞瘤（25.4%）和弥漫性内在脑桥胶质瘤（DIPG）（24.1%）。中位抗肿瘤方案数为 2 个（范围 0-5 个方案）。在姑息治疗阶段，52.2%的患儿接受了 PC 团队的治疗，而 47.8%的患儿仅接受了儿科肿瘤团队的治疗。最常见的关注问题包括运动障碍（93.4%）、乏力（87.5%）和沟通障碍（89.8%）。最常开的支持性药物包括止吐药（83.6%）、阿片类药物（81.6%）和地塞米松（78.5%）。48.7%的患儿接受了 PS。他们大多数（85.6%）在医院死亡，而在家中死亡的患儿（14.4%）需要 PS 的频率较低（p = .01）。
死于中枢神经系统肿瘤的儿童在姑息治疗阶段有特殊需求。PS 的最佳适应证取决于中心的经验，尽管在我们的系列研究中，它也受到死亡地点的影响。
