Respiratory symptoms in children dying from malignant disease

Abstract

Shortness of breath and other respiratory symptoms frequently complicate the symptomatic management of terminally ill adults. The extent of the problem in children is not known, but anecdotal evidence from nurses and physicians experienced in paediatric oncology has suggested that respiratory problems are less frequent in children dying from malignant disease than in adults. This is a retrospective review of all children dying from cancer under the care of the symptom care team at the Royal Marsden Hospital between 1982 and 1993. The results show that respiratory symptoms were recorded during the last three months of life in 40% of analysable case histories. The nature of respiratory symptoms in paediatric cancer patients is discussed.

Pulmonary Dysfunction in Pediatric Oncology Patients

“…Treatment of dyspnea has to be tailored to the patient's clinical condition and should interfere as little as possible with routine daily activities that can still be done by the terminally ill child. The caregiver should be aware of the fact that appropriate treatment of dyspnea will add a substantial benefit to the terminally ill child [23,94,95]. As the child's primary caregivers, parents must be included fully in the care team-provided with information, taught appropriate skills, and assured that advice and support is available 24 hours a day [91].…”

Caring for the Child With Cancer at the Close of Life

“…Dyspnea is a third common symptom among children with advanced cancer and results in substantial suffering. 25,54,55 Its differential diagnosis is important to elucidate because treatments differ considerably.…”

Palliation of Dyspnea in pediatrics

“…Although reduction in dyspnea in pediatrics is enhanced by a thorough understanding of the causes, in many cases we must begin to relieve the symptoms before the exact pathophysiologic process is clear and before there is solid evidence in the pediatric literature to guide our treatment decisions. 9 In general, this leads to a willingness for a trial and error approach, but such an approach must be undertaken with full understanding of the parents as well as with an agreed-upon set of outcomes by which the efficacy of any given treatment can be judged. Often in pediatrics, we are balancing the burden of treatment against the expected outcome for the child.…”