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23-11-2011 | General practice | Article

Parents prefer aggressive palliative treatment for their children with cancer


Free abstract

MedWire News: Parents of children with terminal cancer more strongly favor aggressive over supportive treatment in the palliative phase and rank hope as a more important factor for making decisions about treatment than healthcare professionals, researchers report.

"The choice between palliative chemotherapy (defined as the use of cytotoxic medications delivered intravenously for the purpose of our study) and supportive care alone is one of the most difficult decisions in pediatric oncology, yet little is known about the preferences of parents and health care professionals," remark Lillian Sung (The Hospital for Sick Children, Toronto, Ontario, Canada) and colleagues.

To investigate, the researchers compared the strength of preference between parents of children whose cancer had no reasonable chance of being cured (n=77) and healthcare professionals (n=128) for supportive care alone versus palliative chemotherapy.

Both groups were asked to consider a hypothetical scenario in which the child's treatment was no longer working and no further treatments were available to cure the child's illness.

The participants were shown visual analog scales to illustrate the anticipated level of the child's quality of life and the expected duration of survival, and then asked which treatment option (chemotherapy vs supportive care) they would favor given these baseline attributes. They were also asked which factors might affect their decision.

The primary outcome measure was the desirability of supportive care alone versus palliative chemotherapy. Higher values suggested that supportive care alone would be preferable to palliative chemotherapy.

Significantly more parents than healthcare professionals favoured chemotherapy over supportive care, at 54.5% versus 15.6%.

For parents, hope and the quality of life of their child were the highest-ranking factors influencing the choice between supportive care and chemotherapy, followed by increased survival time.

For healthcare professionals, the child's quality of life was ranked as the most important factor, followed by increased survival time.

In addition, both parents and healthcare professionals reported "child opinion" and "religion/faith/spirituality" as important factors.

Despite the high importance ranking they assigned to their child's quality of life, parents reported that they would accept chemotherapy even if it reduced both quality of life (by two units on a 10-unit visual analog scale) and survival time (by 2 months).

"This finding shows the complexity of decision-making. It is possible that hope for a cure is such an important factor that it may override considerations of the child's quality of life and survival time," Sung and co-authors remark in the Canadian Medical Association Journal.

By contrast, healthcare professionals would require a median increment of two units in quality of life or an additional 2 months survival time to be associated with chemotherapy before considering it worthwhile.

"Understanding the differences between parents and healthcare professionals in the relative desirability of supportive care alone may aid in communication and improve end-of-life care for children with cancer," Sung and co-authors conclude.

In an accompanying editorial, Caprice Knapp and Kelly Komatz, from the University of Florida in Gainesville, USA, say that Sung and team have conducted "an impressive study."

They add that extension of the work is warranted: "Future studies might explore how these results differ for programs where curative and supportive teams are integrated. In such programs, multidisciplinary teams of health care professionals work together with families to address both active treatment and support. When families become familiar with both concepts, the eventual transition should be easier for parents to accept."

By Laura Dean

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