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Transition to noncurative end-of-life care in paediatric oncology – a nationwide follow-up in Sweden

Authors


Correspondence

Li Jalmsell M.D., Centre for Research Ethics and Bioethics, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden. Tel: + 46 18 471 62 19 | Fax: +46 18 471 66 75 |

Email: li.jalmsell@crb.uu.se

Abstract

Aim

To estimate whether and when children dying from a malignancy are recognized as being beyond cure and to study patterns of care the last weeks of life.

Methods

A nationwide retrospective medical record review was conducted. Medical records of 95 children (60% of eligible children) who died from a malignancy 2007–2009 in Sweden were studied.

Results

Eighty-three children (87%) were treated without curative intent at the time of death. Children with haematological malignancies were less likely to be recognized as being beyond cure than children with brain tumours [relative risks (RR) 0.7; 95% confidence interval (CI) 0.6–0.9] or solid tumours (RR 0.8; 0.6–1.0). The transition to noncurative care varied from the last day of life to over four years prior to death (median 60 days). Children with haematological malignancies were treated with a curative intent closer to death and were also given chemotherapy (RR 5.5; 1.3–22.9), transfusions (RR 2.0; 1.0–4.0) and antibiotics (RR 5.3; 1.8–15.5) more frequently than children with brain tumours the last weeks of life.

Conclusion

The majority of children dying from a malignancy were treated with noncurative intent at the time of death. The timing of a transition in care varied with the diagnoses, being closer to death in children with haematological malignancies.

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