title: Analysis of the circumstances at the end of life in children with cancer: symptoms, suffering and acceptance.
abstract: BACKGROUND
  In an effort to improve the quality of life of children with cancer, this study analyzes the signs and symptoms at the end of life in such children. It is hoped that these data will contribute to the development of appropriate programs to address the challenges faced by these children.
  
  
  METHODS
  Between 1994 and 2000, 28 children died after treatment for cancer at Hamamatsu University Hospital, Japan. The circumstances, signs and symptoms at the end of life of these children were analyzed through their medical records.
  
  
  RESULTS
  Of the 28 children, the underlying diseases were leukemia/lymphoma (LL group; n=11), brain tumors (BT group; n=7), and other solid tumors (OST group; n=10). Records showed poor appetite (100%), dyspnea (82.1%), pain (75.0%), fatigue (71.4%), nausea/vomiting (57.1%), constipation (46.4%) and diarrhea (21.4%) among these children. Anxiety was reported in 53.6% of the entire group of 28 children; however, no child in the BT group manifested anxiety. However, disturbance of consciousness was reported in all children in the BT group, which was significantly greater than in the other groups. Awareness, fear or acceptance of the imminence of his/her own death as indicated by verbal expression was reported in nine children (32.1%).
  
  
  CONCLUSIONS
  Using the data obtained in the present study, we describe situations faced in the terminal care of children. It is important to address the problems revealed by this analysis in order to achieve improvements in both the physical and psychological care of children with terminal cancer.
authors.affiliation: Hamamatsu University School of Medicine, Shizuoka, Japan. hongot@hama-med.ac.jp
authors.forename: Teruaki
authors.initials: T
authors.lastname: Hongo
authors.forename: Chieko
authors.initials: C
authors.lastname: Watanabe
authors.forename: Shuichi
authors.initials: S
authors.lastname: Okada
authors.forename: Noriko
authors.initials: N
authors.lastname: Inoue
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yajima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Fujii
authors.forename: Takehiko
authors.initials: T
authors.lastname: Ohzeki
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000628:therapy; D008223:Lymphoma / Q000628:therapy; D008297:Male; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D012944:Social Support; D013727:Terminal Care