Better understanding of prognosis linked to greater emphasis on easing suffering of children with advanced cancer

BOSTON There is considerable delay among parents in recognizing when children with advanced cancer have no realistic chance of cure, according to a Dana-Farber Cancer Institute and Childrens Hospital-Boston study published in the November 15 issue of The Journal of the American Medical Association (JAMA).

Researchers conclude earlier recognition of this prognosis by both parents and physicians could lead to stronger emphasis on treatment directed at lessening suffering and greater integration of palliative care.

Caregivers and parents are appropriately committed to curing children with cancer, says Joanne Wolfe, MD, MPH, Instructor in Pediatrics at Harvard Medical School, Dana-Farber Cancer Institute and Childrens Hospital, and lead author of the study. Unfortunately, not all children will survive, so its important that we emphasize effective integration of palliative care at the same time as treatment of the underlying disease.

The authors interviewed 103 parents of children who died of cancer between 1990 and 1997, as well as surveyed the child's primary oncologist and reviewed their medical charts. They asked when parents and physicians became aware that the child had no realistic chance for cure; what factors were associated with a greater similarity in the timing of parent and physician awareness that the child was terminally ill; whether understanding the child's prognosis altered parents' treatment goals; and what outcomes were associated with earlier parent-physician recognition of prognosis.

On average, physicians recognized that the child had no realistic chance for cure around 100 days earlier than did the parents. When both parent and physician recognized the childs prognosis more than 50 days prior to death, there was a stronger emphasis on treatment aimed at lessening suffering. The authors report that there was earlier documentation of a discussion of hospice, better parental ratings of the quality of care delivered by the hom

Contact: Todd Ringler or Janet Haley
Dana-Farber Cancer Institute

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