title: Analysis of the circumstances at the end of life in children with cancer: a single institution's experience in Japan.
abstract: BACKGROUND
  With the aim of improving the quality of life of children with cancer, this study presents an analysis of one hospital's experience with terminal care.
  
  
  METHODS
  Between 1994 and 2000, 28 children died after treatment for cancer at Hamamatsu University Hospital. The circumstances of their deaths were analyzed through medical records and interviews with 8 sets of bereaved parents. We compared results of this analysis with our previous data collected from 1978 to 1993.
  
  
  RESULTS
  Of the 28 children, 11 had leukemia/lymphoma (LL group) and 17 had solid tumors (ST group). Six children (21.4%), all of whom were in the LL group, died of treatment-related complications. Twenty children (71.4%) died during terminal care: three (27.3%) were in the LL group and 17 (100%) in the ST group. Eleven children (39.3%) received terminal care at home and eight (28.6%) of these died at home. The number of children who received terminal care and died at home had increased in comparison with the previous period. Among problems with terminal care identified by parents were the lack of opportunity for the child to continue with education and an inadequate support system after the child's death.
  
  
  CONCLUSIONS
  Some advances in the quality of life of the children were recognized. However, these advances were extended to a greater percentage of children in the ST group than in the LL group. The psychosocial problems faced by children and their families are now changing for the better.
authors.affiliation: Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Fujii
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: Akira
authors.initials: A
authors.lastname: Endoh
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yajima
authors.forename: Teruaki
authors.initials: T
authors.lastname: Hongo
authors.forename: Takehiko
authors.initials: T
authors.lastname: Ohzeki
authors.forename: Eriko
authors.initials: E
authors.lastname: Suzuki
mesh_terms: D000293:Adolescent; D000328:Adult; D001601:Bereavement; D002648:Child; D002673:Child, Hospitalized / Q000523:psychology*; D002675:Child, Preschool; D005192:Family Health; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007564:Japan; D008297:Male; D009369:Neoplasms / Q000145:classification / Q000523:psychology* / Q000628:therapy; D011788:Quality of Life; D012944:Social Support; D013727:Terminal Care / Q000458:organization & administration / Q000523:psychology / Q000592:standards; D019452:Terminally Ill / Q000523:psychology*