PALLIATIVE CARE AND QUALITY OF LIFE IN NEURO-ONCOLOGY: THE EXPERIENCE AT THE MEYER CHILDREN'S HOSPITAL

Introduction: In order to allow the young patient with CNS tumor to experience a peaceful death, specific palliative interventions are required for the control of pain, loss of consciousness, cognitive disturbances, communication and motor function deficits. The lack of control of symptoms can often lead to re-hospitalization with a resultant in a worsening of patient’s quality of life. There are few small series described on the of end-of-life care in pediatric patients with brain tumor. Materials and Methods: We retrospectively considered 93 patients with brain tumor, followed at the Neuro-Oncology Unit died between September 2008 and January 2016. The median age at diagnosis was 7,6 years (range 2-165);47 patients were male and 46 female; 51 were astrocytic tumors, 34 embryonal tumors, 5 ependymal tumors, 2 germ cell tumors and 1 choroid plexus carcinoma. We collected also data about symptoms of the last 6 month of life, the support therapy and the receiving palliative care. Results: 70 of 93 patients underwent to palliative care; at transition to end-of-life approach 28 were oligo-symptomatic (maximum 2 symptoms), 42 with more than 2 symptoms. The median overall survival was 13, 7 months with a small prevalence for the female gender. In the group of 70 children, 49 died at home, 15 in hospice, 6 in hospital. We did not find statistically significant differences of the median survival among patients receiving end-of-life care compare to those not- treated. Conclusions: Our experience confirms the importance of personalized palliative approach for young patient with brain tumor in order to achieve a peaceful death. This objective requires a careful evaluation of clinical signs and symptoms to perform an effective therapy for each individual case. Therefore, it is of paramount importance to plan and discuss end-of-life decisions in advance with the patient’s family.