临终（EOL）时的痛苦会影响人们对“美好的死亡”的看法，并最终影响癌症儿童家庭的丧亲之痛。姑息放射 (pXRT) 是一种可以解决疼痛、减轻痛苦和改善生活质量的工具。对 11 年内死亡的儿科肿瘤患者的回顾性病历审查已经完成。使用描述性分析和非参数检验来比较各组。研究期间共有 2202 人死亡； 167 名患者符合研究标准，反映出 EOL 时 pXRT 使用的发生率为 7.6%。大多数患者为白人 (68%) 和男性 (59%)，中位年龄为 9 岁。实体瘤最常见（52%），其次是中枢神经系统肿瘤（38%）和白血病（10%）。 pXRT 主要用于治疗疼痛 (37%)，重点治疗部位包括大脑/脊柱 (37%)、头/颈部 (24%) 和骨盆 (12%)。平均辐射剂量为 23.8Gy（范围：1.8-55.8Gy），中位数为 7 个部分（范围：1-31）。副作用很少见，58% 的患者报告的疼痛评分有所下降。此外，87% 的人接受了儿科姑息治疗 (PPC) 咨询，这增加了临终关怀转诊的可能性、记录了 DNR 偏好并减少了死亡当天的 CPR 次数。儿科 EOL 期间 pXRT 的使用未得到充分利用且存在显着差异肿瘤学。该工具的障碍可能包括医生的看法、家庭/患者的偏好和后勤困难。 pXRT 标准化指南以及早期 PPC 集成可以指导临床医生决策并提高 pXRT 利用率。版权所有 © 2024。由 Elsevier Inc. 出版。

Suffering at the end-of-life (EOL) can impact the perception of a "good death" and ultimately affect bereavement for families of children with cancer. Palliative radiation (pXRT) is a tool that can address pain, mitigate suffering and improve quality of life.A retrospective medical record review of pediatric oncology patients who died over an 11-year period was completed. Descriptive analysis and non-parametric tests to compare groups were used.2202 total deaths occurred during the study period; 167 patients met study criteria, reflecting a 7.6% incidence of pXRT use at the EOL. Most patients were white (68%) and male (59%), with a median age of 9 years. Solid tumors were most common (52%), followed by CNS tumors (38%), and leukemia (10%). pXRT was primarily used to treat pain (37%) and focused on sites including brain/spine (37%), head/neck (24%), and pelvis (12%). Mean radiation dose delivered was 23.8Gy (range: 1.8-55.8Gy) in a median of 7 fractions (range: 1-31). Side effects were rare and 58% of patients had a decrease in reported pain scores. Additionally, 87% received a pediatric palliative care (PPC) consultation which increased the likelihood for hospice referral, documented DNR preferences and decrease episodes of CPR on the day of death.There is underutilization and significant variability in the use of pXRT during EOL in pediatric oncology. Barriers to this tool may include physician perceptions, family/patient preferences, and logistical hardships. Guidelines to standardize pXRT, alongside earlier PPC integration, may guide clinician decision making and increase pXRT utilization.Copyright © 2024. Published by Elsevier Inc.