title: Critical Situations in Children, Adolescents and Young Adults with Terminal Cancer within the Home Setting.
abstract: BACKGROUND
  Over the course of terminal cancer towards the end-of-life, children may experience symptoms that lead to distressing critical situations (CS) for the child and caregivers.
  
  
  METHODS
  We analysed the records of 133 children cared for by our paediatric palliative care team (PPCT) from 01/98-12/09. A CS was defined as deterioration of a condition caused by a symptom, which was life-threatening or acutely scaring the patient (pt) or caregivers.
  
  
  RESULTS
  The majority of pts who died sustained no CS. In 38 (28.6%) pts 45 CS occurred. These accumulated towards the end-of-life (62.2% within the last week). About two-thirds were anticipated. There was no clustering of CS during the night/weekend. Leading symptoms were neurological. In 4 CS a pre-hospital emergency physician was alerted. 5 pts were readmitted to hospital. Most CS (88.9%) could be controlled in the home setting.
  
  
  CONCLUSIONS
  Despite anticipation, a relevant number of pts developed CS, which needed either additional medical intervention or other support by the PPCT. Considering the distressing and suffering character of status epilepticus and dyspnoea, it is important to thoroughly address these conditions in palliative care.
  
  
  CONCLUSIONS
  Advanced planning, close contact, good communication, detailed parental information, and a 24-h on-call service can reduce CS in children with terminal cancer. CS are mainly manageable within the home setting. Treatment of CS should focus on the child's symptoms and wishes, and the needs of the whole family.
authors: Department of Paediatric Oncology, Haematology and Clinical Immunology, Center for Child and Adolescent Health, Heinrich Heine University, Duesseldorf, Germany.
authors: M
authors: M
authors: Kuhlen
authors: Department of Paediatric Oncology, Haematology and Clinical Immunology, Center for Child and Adolescent Health, Heinrich Heine University, Duesseldorf, Germany.
authors: S
authors: S
authors: Balzer
authors: Department of Paediatric Oncology, Haematology and Clinical Immunology, Center for Child and Adolescent Health, Heinrich Heine University, Duesseldorf, Germany.
authors: C
authors: C
authors: Friedland
authors: Department of Paediatric Oncology, Haematology and Clinical Immunology, Center for Child and Adolescent Health, Heinrich Heine University, Duesseldorf, Germany.
authors: A
authors: A
authors: Borkhardt
authors: Department of Paediatric Oncology, Haematology and Clinical Immunology, Center for Child and Adolescent Health, Heinrich Heine University, Duesseldorf, Germany.
authors: G
authors: G
authors: Janßen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D018450:Disease Progression; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006699:Home Care Services; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000628:therapy*; D010359:Patient Readmission; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D055815:Young Adult