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[Transfer to intensive care units for children with neoplasms: what decision-making tools are available?]
1Unité Protégée A, clinique de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille, France. jhdalle@yahoo.fr
Insights
Pediatric cancer patients admitted to intensive care units require collaborative care between pediatric oncologists and intensive care physicians. Developing validated prognostic scores is crucial for informed decision-making and anticipating care needs.
Area of Science:
- Pediatric Oncology
- Pediatric Critical Care Medicine
Context:
- Advances in pediatric cancer treatment lead to more children requiring intensive care.
- There's a growing need for collaboration between pediatric oncologists and pediatric intensive care physicians.
Purpose:
- To explore the current tools and challenges in guiding decision-making for pediatric oncology patients in the intensive care unit.
- To highlight the necessity of multidisciplinary discussions at various stages of a child's disease trajectory.
Summary:
- Few studies address outcomes for pediatric oncology patients in intensive care, and adult data is not directly applicable.
- Decision-making requires extensive debate among oncologists, intensivists, nurses, psychologists, and families.
- Anticipating decisions before intensive care unit transfer is recommended.
Impact:
- Highlights the need for validated prognostic scores specific to pediatric oncology patients in intensive care.
- Emphasizes the importance of a multidisciplinary and family-centered approach to care planning.
- Aims to improve the quality of care and decision-making processes for critically ill children with cancer.
Abstract:
As a result of major progresses in anti-cancer treatment, many children with malignancy have to be admitted to an intensive care unit. Therefore it has become a necessity for paediatric oncologists and haematologists and paediatric intensive care physicians to work together. What are the current tools to guide their discussion and decision? There are few useful published studies about the outcome of oncology paediatric patients admitted to intensive care unit. Due to the very specificity of paediatric oncology it is difficult to extrapolate from the available adult studies. Legislative texts specify the limits of the debate but feed it little. Philosophers concentrate on the risk of therapeutic doggedness and the right to dye with dignity. The oncology paediatric patients may be sent to an intensive care unit at different steps of their diseases: at the time of diagnosis, during the curative treatment, or after treatment failure. For each step, there is a need for a wide debate between oncologists, intensivists, nurses, psychologists, and the child's family in order to define the most consensual decisions. The development of validated prognostic scores for this particular population will be very helpful for the decision making. As frequently as possible the decision should be anticipated before the transfer of the child to the intensive care unit.