"Do not resuscitate" orders among children with solid tumors at the end of life

The goal of this study was to evaluate the frequency and timing of "do not resuscitate" (DNR) orders among pediatric oncology patients with progressive solid tumors. A retrospective evaluation of the medical charts of 36 patients who died in our department over the last 4 years was made. There were 21 males and 15 females with a mean age of 10 years (range, 1-22 years). Fourteen patients had brain tumors, 12 had sarcomas, 5 had lymphomas, 4 had neuroblastomas, and 1 suffered from hepatocellular carcinoma. A DNR order was registered in the medical charts of 22 (61%) patients. The DNR was ordered within less than 24 h of death in 5 patients. Median time from DNR order until death was 5 days (range, 0.25-82 days). Place of death was home for 5 (14%) patients, 3 of whom had DNR orders; pediatric oncology ward for 28 (78%), 19 of whom had DNR orders); ICU for 3 (8%), none with a DNR order. Mean time from last day of anticancer treatment until death was 63 days in the group with DNR orders and 56.5 days in the group without DNR orders (p = NS). The study showed that (1) DNR orders were written in only about half the charts of patients with progressive cancer; (2) in several cases, DNR orders were given close to death; and (3) advanced discussion of DNR with parents is needed to reduce parental and medical staff stress accompanying the death of a child and optimizing management of the terminal phase of the disease.