Analysis of the circumstances at the end of life in children with cancer: A single institution's experience in Japan

Abstract

Some advances in the quality of life of the children were recognized. However, these advances were extended to a greater percentage of children in the ST group than in the LL group. The psychosocial problems faced by children and their families are now changing for the better.

End-of-life experience of children undergoing stem cell transplantation for malignancy: parent and provider perspectives and patterns of care

“…Several studies have documented patterns of care and symptoms and suffering that such children experience. [11][12][13][14][15][16][17][18][19] Exploration of parent and physician perspectives has also revealed their communication patterns and understanding of prognosis at EOL. 20,21 EOL experiences have often been evaluated according to factors, such as the child's cancer diagnosis, 12,13,16,17,19 age, 12,18 location of EOL care, 19 or type of death (ie, progressive disease or treatment-related complication).…”

“…Despite this, very little is known about the experience of children who undergo SCT but do not survive. Studies of children with cancer have occasionally included SCT recipients, 11,14,15 but only 1 specifically describes outcomes in this group. 14 By review of medical records, Bradshaw et al demonstrated that children who underwent SCT were more likely to experience a pulmonary or cardiovascular complication, were less likely to die at home, and had a do-not-resuscitate (DNR) order in place for a shorter period of time before death.…”

Determinants of Hospital Death for Taiwanese Pediatric Cancer Decedents, 2001–2010

“…In other countries, the percentages of hospital death for pediatric cancer patients not specifically under palliative care were 31.0%e60.2% in Germany, 3,11,25e27 33.9% e56.3% in the U.S., 6,10,15,16,28,29 37.2% in New Zealand, 5 39.0% in Australia, 4 43.3%e47.0% in England and Wales, 8,14 61.0% in Sweden, 2 and 71.4% in Japan. 9 Furthermore, place of death for Taiwanese pediatric cancer patients slightly shifted from home death to hospital death, reaching significance in 2009. This finding is similar to reports from the U.S. 6 and Germany, 3 but contrasts with the increasing trend for pediatric cancer patients in the U.S. 29 and Japan 9 to die at home rather than a hospital.…”

“…Taiwanese children diagnosed with leukemia and lymphoma had a greater likelihood of dying in an acute care hospital, consistent with the literature. 2,8,9,14,16,29 However, Taiwanese pediatric cancer patients were more likely to die in an acute care hospital if they resided in the most urbanized area, in contrast to home death being associated with more affluent socioeconomic status in the U.S. 29 and England, 8,14 but not in New Zealand 5 and European countries. 7 In the most urbanized area of Taiwan, the population density is high, with most families living in small apartments in three-to five-floor buildings without elevators, making EOL care or death at home more difficult than in Taiwan's rural areas.…”

“…2,8,9,14e16 Furthermore, except for epidemiologic studies conducted in England 8,14 and Sweden, 2 previous studies on factors influencing terminally ill pediatric cancer patients' place of death were primarily based on data from a single institution. 6,9,15,16 For the previous population-based studies, 2,14 the data are almost 20 years old. Thus, factors influencing pediatric cancer patients' place of death may have evolved with advances in medical and hospice care.…”