title: Predictors of symptoms and site of death in pediatric palliative patients with cancer at end of life.
abstract: OBJECTIVE
  To describe how preferences and treatment influence symptoms at end of life and site of death in pediatric cancer.
  
  
  METHODS
  We included 61 pediatric palliative patients with cancer whose parents previously participated in a study that elicited preferences for aggressive chemotherapy versus supportive care alone and who subsequently died. Main outcomes were severe pain and dyspnea proximal to death and site of death.
  
  
  RESULTS
  Choice of aggressive chemotherapy predicted significantly more severe pain (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.0-9.6; P = .049). Intravenous chemotherapy 4 weeks before death predicted severe dyspnea (OR 15.8, 95% CI 3.7-67.5; P < .001) and death outside the home (OR 0.3, 95% CI 0.1-0.9; P = .038).
  
  
  CONCLUSIONS
  Parental choice of aggressive chemotherapy and more aggressive treatment proximal to death predicted more pain, dyspnea, and death in hospital. Strategies to improve quality of life are needed.
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Schindera
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Tomlinson
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Ute
authors.initials: U
authors.lastname: Bartels
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Biljana
authors.initials: B
authors.lastname: Gillmeister
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Alli
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada lillian.sung@sickkids.ca.
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001293:Attitude to Death; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D004417:Dyspnea / Q000150:complications; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D010146:Pain / Q000150:complications; D010166:Palliative Care / Q000379:methods*; D010290:Parents; D011788:Quality of Life; D012737:Sex Factors; D013727:Terminal Care / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents
keywords: cancer; decision making; end of life; palliative care; pediatric; site of death; treatment choice