title: Parents' views of cancer-directed therapy for children with no realistic chance for cure.
abstract: OBJECTIVE
  Previous literature suggests that parents often wish to continue cancer-directed therapy for their children with incurable cancer. We assessed parents' experiences with treatment for their children with cancer and no realistic chance of cure.
  
  
  METHODS
  We administered questionnaires to 141 parents of children with cancer who died after receiving care at one of two cancer centers. Parents were asked whether the child benefited and suffered from treatment administered after the parent recognized that cure was not a realistic expectation, and whether they would recommend cancer-directed therapy to other families of children with advanced cancer.
  
  
  RESULTS
  Fifty-three (38%) of 141 children received cancer-directed therapy after the parent recognized that the child had no realistic chance for cure. Most of these parents felt that their child had experienced at least some suffering resulting from the therapy (61%, 31 of 51) and little to no benefit (57%, 29 of 51). Fifty-one (38%) of 135 parents overall would recommend standard chemotherapy and 46 (33%) of 140 would recommend experimental chemotherapy to families of children with advanced cancer. Even parents who would not recommend standard chemotherapy generally felt the physician should offer it (91%, 88 of 97). Parents who reported that their children experienced suffering resulting from cancer-directed therapy (odds ratio = 0.46; P = .02) were less likely to recommend standard chemotherapy to other families.
  
  
  CONCLUSIONS
  Although many parents choose treatment for their children with incurable cancer, bereaved parents often would not recommend such therapy. Parents who felt their children suffered as a result of cancer treatment were particularly unlikely to recommend it.
authors.affiliation: Center for Outcomes and Policy Research and Department of Pediatric Oncology, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115, USA. Jennifer_mack@dfci.harvard.edu
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Mack
authors.forename: Steven
authors.initials: S
authors.lastname: Joffe
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Hilden
authors.forename: Jan
authors.initials: J
authors.lastname: Watterson
authors.forename: Caron
authors.initials: C
authors.lastname: Moore
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000523:psychology*; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*
chemical_list: D000970:Antineoplastic Agents
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