title: Variables influencing end-of-life care in children and adolescents with cancer.
abstract: BACKGROUND
  The purpose of this study was to describe the variables influencing end-of-life care in children and adolescents dying of cancer.
  
  
  METHODS
  Records of 146 children with cancer who died at Children's Hospital were reviewed for demographics, diagnosis, location of death, withdrawal of life support, use of "do not resuscitate" (DNR) orders, and the length of time that those orders were in effect.
  
  
  RESULTS
  Ninety-five patients were evaluated. Fifty-nine died of progressive disease and 36 deaths were therapy-related. Sixty-four percent of disease-related deaths occurred at home with support from home care or hospice. Only 10% of all patients died while receiving maximal aggressive support in the intensive care unit. Age, diagnosis (solid tumor vs. leukemia), cause of death, length of last hospital admission, and the duration of DNR orders had a significant correlation with the place of death and referral to and use of hospice. Thirty-five percent of all patients had hospice support.
  
  
  CONCLUSIONS
  Most children who die of cancer die because of progressive disease at home with hospice support. Do not resuscitate orders were written for most patients who died. End-of-life decisions are influenced by patient diagnosis, cause of death, and age.
authors.affiliation: Department of Pediatrics, Children's Hospital, Columbus, Ohio 43205, USA. kklopfen@chi.osu.edu
authors.forename: K J
authors.initials: KJ
authors.lastname: Klopfenstein
authors.forename: C
authors.initials: C
authors.lastname: Hutchison
authors.forename: C
authors.initials: C
authors.lastname: Clark
authors.forename: D
authors.initials: D
authors.lastname: Young
authors.forename: F B
authors.initials: FB
authors.lastname: Ruymann
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006699:Home Care Services; D017051:Hospice Care; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000628:therapy*; D016414:Resuscitation Orders; D013727:Terminal Care / Q000639:trends*; D028761:Withholding Treatment