Palliative chemotherapy and radiotherapy

Publicado 19 diciembre, 2023

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Clinical Practice Guideline on Palliative Care in Paediatrics

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Introduction Pharmacological treatment of moderate to severe pain in paediatric palliative care Palliative chemotherapy and radiotherapy Child participation in decision-making and end-of-life care Communication with the patient and family The preferred location for end-of-life care Symptom assessment in paediatric palliative care

Question

Does the use of palliative chemotherapy/radiotherapy in children and adolescents with PPC increase survival, their quality of life, and/or improve symptom control?

Recommendations

Healthcare professionals must explain to the patient (according to their level of development), and family, the benefits, risks, and possible associated distress of the treatment options (palliative radiotherapy, palliative chemotherapy, or supportive care), in an honest, simple, approachable, accessible, and coherent way, using all relevant information so that they can participate in the decision. In addition to active listening and appropriate silence, in order to be aware of their needs at all times.
Healthcare professionals should reinforce information about the PPC patient’s prognosis and the treatment options available at each stage of the disease, tailored to the individual needs of the patient and family, with the aim of creating realistic expectations.

For aspects related to communication and treatment decision-making processes, it is suggested to refer to the recommendations in Chapters Child participation in decision-making and end-of-life care and Communication with the patient and family of the guidelines.

In the management of symptoms in PPC, an individualised assessment is suggested to diagnose and, if possible, treat the specific causes. In paediatric patients with advanced cancer in palliative care, the use of palliative radiotherapy should be considered on a case-by-case basis, depending on the location and type of tumor.

Rationale

The CDG believes that palliative RT can be integrated into the end-of-life care process for children and adolescents with incurable cancer. Although the evidence is of very low quality, all series show that palliative RT improves symptoms in most patients, without significant toxicity.

The CDG has decided not to make a recommendation on palliative QT based on the evidence identified. Further studies are needed on the effectiveness and safety of its use in the paediatric age group.

Finally, general practical considerations were made about the need to clarify the goal of treatment with the patient and family in order to avoid, as far as possible, unrealistic expectations leading to unnecessary treatment.

Complete clinical question

Full information on this question (available in Spanish), see:

http://portal.guiasalud.es/guia-en-capas/cuidados-paliativos-pediatria/#question-2

References

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