A retrospective study, conducted in Marseille by Dr. Gabriel Revon-Rivière and published last March, showed that palliative care was not systematic in pediatric oncology.
The report is without appeal. "Although the organisation of paediatric palliative care has been structured in France thanks to the 2008-2012 ministerial palliative care plan," reminds the French Society of palliative care (SFAP), the palliative culture is hardly being developed in paediatric practice. This was revealed in a study conducted by Dr. Gabriel Revon-Rivière, a physician working for the Regional Resource Team on Pediatric Palliative Care (ERRSPP) in Alpes-Maritimes region (1) and published in March.
1899 children and youth files reviewed
As part of this research, 1899 files of children and adolescents who died of cancer were studied. The study shows that from the 80% who died in hospital, 61.4% received intensive care (chemotherapy, hospitalization in intensive care units or a visit to the emergency room) in the last 30 days of life and 28.8% received invasive care (intubation, mechanical ventilation, cardiopulmonary resuscitation or even hemodialysis). "It is a proven fact. In adults, early palliative care has positive effects on the patient's quality of life and survival" (2), says Dr. Gabriel Revon-Rivière. "However, we found that among young patients who received palliative care, intensive care was significantly reduced. Indeed, of the 1899 young subjects in the study, only 51.2% received intensive care during their palliative care before their last month of life.
The poorly identified palliative problem?
The results also reveal that 70.2% of the children and adolescents in the study received intensive care during palliative care during their last month of life. Similarly, 82.8% of them received intensive care without being able to benefit from palliative care.
Thus, this late use of intensive care in the last month of life could suggest "that the palliative problem has not been identified and that the care of the child or adolescent has probably continued to the detriment of quality of life," according to Dr. Revon-Rivière. He added: "the small number of expert structures in pediatric palliative care, the reluctance of caregivers to consider such care and the lack of data available to medical teams to assess the prognosis of young cancer patients", could well explain this finding.
- Revon-Rivière G. et al. High-intensity end-of-life care among children, adolescents, and young adults with cancer who die in the hospital: A population-based study from the French national hospital database. Cancer. 2019 Mar 26. doi: 10.1002/cncr.32035.
- Boulec C. et al. Early palliative care in oncology. Bull Cancer. 2019 Jun 4. pii: S0007-4551(19)30197-3. doi: 10.1016/j.bulcan.2019.04.006.