Pediatric hematology-oncology palliative care in Ile-de-France area. [French]

Abstract

Purpose. ‘ The aim was to assess the need for palliative care by describing the pathway of care for children during their last three months of life treated for a cancer or hematology disease in Paris area and who died in 2010. This work was conducted by the Reseau d’Ile-de-France d’hematologie et oncologie pediatrique ([RIFHOP], pediatric oncology network) and Equipe regionale ressource en soins palliatifs pediatriques en Ile-de-France ([PALIPED], palliative care team). Methods. ‘ This is a retrospective multicentric review from medical records of 68children. Results. ‘ Palliative care decisions were retrospectively found in medical charts during a multidisciplinary discussion in 70% of cases, and non-resuscitation decisions was available in 40%. Children in palliative care died mainly in the hospital (78.5%), less often at home (21.5%). The initial choice of death location was respected in 60% of cases. During the end of life period, 80% of children received morphine, 91 % steroids, 21 % chemotherapy, and 53% antibiotics; 47% had blood transfusion and 57% were sedated at the very end. Conclusion. ‘ This retrospective study provides a detailed description of the course of care of children in palliative setting followed in oncology or hematology in Ile-de-France during the last three months of life. The development of non-drug means comfort, the pursuit of certain invasive procedures or certain treatments in the last week of life, the place of end of life or the city-hospital coordination are all working axis highlighted by this study.