Palliative care in pediatric patients with central nervous system cancer: Descriptive and comparative study.

OBJECTIVES: Data regarding the palliative needs of pediatric patients with central nervous system (CNS) cancer are scarce. We aimed to describe the attention provided by a pediatric palliative care (PPC) team to patients with CNS cancer and the differences in care compared to patients who did not receive PPC. METHOD: This retrospective study was based on the clinical records of deceased patients with CNS cancer attended by a PPC team over 10 years, analyzing their trajectory and provision of PPC, including medical, psychological, social, and nursing interventions. Furthermore, we compared the last month of life care of deceased patients with CNS cancer in the same institution, based on whether they were attended by the PPC team. RESULTS: Of 71 patients, 59 received PPC, with a median of 1.6 months (Interquartile range: 0.6-5.2) from referral to death. Home hospitalization was provided to 84.8%, nursing interventions were registered in 89.8%, psychological characteristics in 84.7%, and social interventions in 88.1%. The most common symptoms were pain, dyspnea, and constipation. When comparing patients from the same hospital who received PPC (n = 36) with those who did not (n = 12), the former spent fewer days in the hospital in their last month and last week (p < 0.01) and were more likely to die at home (50% vs. 0%; p < 0.01). SIGNIFICANCE OF RESULTS: Patients with CNS cancer show various medical, social, and psychological needs during end-of-life care. Providing specific PPC interventions decreased the number of days spent at the hospital and increased the rate of death at home.

Radioterapia paliativa pediátrica / Pediatric palliative radiotherapy

Introducción: La radioterapia es un recurso infrautilizado en los cuidados paliativos pediátricos; sin embargo, tiene utilidad para aliviar diversos síntomas al final de la vida. Pacientes y métodos: Se muestra un estudio retrospectivo de 30 pacientes pediátricos que han recibido radioterapia por motivos paliativos. El objetivo fue revisar si la radioterapia resultó efectiva. Resultados: La radioterapia fue útil para aliviar los síntomas, mostrando una respuesta global en el 85 % de los casos y presentando toxicidades leves. Las respuestas más pobres fueron en gliomas con alivio sintomático en el 56 % de los casos, mostrando toxicidades en el 89 % de los mismos. La necesidad de anestesia supuso un factor de riesgo para el desarrollo de toxicidades. Conclusiones: El uso de la radioterapia paliativa es beneficiosa y debe incluirse en el manejo multidisciplinar del niño en cuidados paliativos. (AU)

Introduction: Radiotherapy is an underutilized resource in pediatric palliative care; however, it has utility in relieving various symptoms at the end of life. Patients and methods: A retrospective study of 30 pediatric patients who received radiotherapy for palliative reasons is reported. The objective was to review whether radiotherapy was effective. Results: Radiotherapy was useful in relieving symptoms, showing an overall response in 85 % of cases and presenting mild toxicities. The poorest responses were found in gliomas, with symptomatic relief in 56 % of cases, showing toxicities in 89 % of cases. The need for anesthesia represented risk factor for the development of toxicities. Conclusions: The use of palliative radiotherapy is beneficial and should be included in the multidisciplinary management of children in palliative care. (AU)