title: Transition to noncurative end-of-life care in paediatric oncology--a nationwide follow-up in Sweden.
abstract: OBJECTIVE
  To estimate whether and when children dying from a malignancy are recognized as being beyond cure and to study patterns of care the last weeks of life.
  
  
  METHODS
  A nationwide retrospective medical record review was conducted. Medical records of 95 children (60% of eligible children) who died from a malignancy 2007-2009 in Sweden were studied.
  
  
  RESULTS
  Eighty-three children (87%) were treated without curative intent at the time of death. Children with haematological malignancies were less likely to be recognized as being beyond cure than children with brain tumours [relative risks (RR) 0.7; 95% confidence interval (CI) 0.6-0.9] or solid tumours (RR 0.8; 0.6-1.0). The transition to noncurative care varied from the last day of life to over four years prior to death (median 60 days). Children with haematological malignancies were treated with a curative intent closer to death and were also given chemotherapy (RR 5.5; 1.3-22.9), transfusions (RR 2.0; 1.0-4.0) and antibiotics (RR 5.3; 1.8-15.5) more frequently than children with brain tumours the last weeks of life.
  
  
  CONCLUSIONS
  The majority of children dying from a malignancy were treated with noncurative intent at the time of death. The timing of a transition in care varied with the diagnoses, being closer to death in children with haematological malignancies.
authors.affiliation: Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden. li.jalmsell@crb.uu.se
authors.forename: Li
authors.initials: L
authors.lastname: Jalmsell
authors.forename: Martin
authors.initials: M
authors.lastname: Forslund
authors.forename: Mats G
authors.initials: MG
authors.lastname: Hansson
authors.forename: Jan-Inge
authors.initials: JI
authors.lastname: Henter
authors.forename: Ulrika
authors.initials: U
authors.lastname: Kreicbergs
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Frost
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D010166:Palliative Care; D010372:Pediatrics / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013548:Sweden; D013727:Terminal Care / Q000706:statistics & numerical data*