Variables influencing end-of-life care in children and adolescents with cancer

Background: The purpose of this study was to describe the variables influen cing end-of-life care in children and adolescents dying of cancer. Materials and Methods: Records of 146 children with cancer who died at Chil dren's Hospital were reviewed for demographics, diagnosis, location of deat h, withdrawal of life support, use of "do not resuscitate" (DNR) orders, an d the length of time that those orders were in effect. Results: Ninety-five patients were evaluated. Fifty-nine died of progressiv e disease and 36 deaths were therapy-related. Sixty-four percent of disease -related deaths occurred at home with support from home care or hospice. On ly 10% of all patients died while receiving maximal aggressive support in t he intensive care unit. Age, diagnosis (solid tumor vs. leukemia), cause of death, length of last hospital admission, and the duration of DNR orders h ad a significant correlation with the place of death and referral to and us e of hospice. Thirty-five percent of all patients had hospice support. Conclusions: Most children who die of cancer die because of progressive dis ease at home with hospice support. Do not resuscitate orders were written f or most patients who died. End-of-life decisions are influenced by patient diagnosis, cause of death, and age.