Originally published as JCO Early Release 10.1200/JCO.2007.15.6059 on September 8 2008

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Parents’ Views of Cancer-Directed Therapy for Children With No Realistic Chance for Cure

Jennifer W. Mack, Steven Joffe, Joanne M. Hilden, Jan Watterson, Caron Moore, Jane C. Weeks, Joanne Wolfe

From the Departments of Pediatric Oncology and Medical Oncology; Center for Outcomes and Policy Research, Dana-Farber Cancer Institute; Department of Medicine, Children's Hospital, Boston, MA; Department of Pediatrics, Peyton Manning Children's Hospital at St Vincent, Indianapolis, IN; and the Department of Pediatric Hematology-Oncology, Children's Hospitals and Clinics, St Paul, MN

Corresponding author: Jennifer W. Mack, MD, MPH, Center for Outcomes and Policy Research and Department of Pediatric Oncology, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115; e-mail: Jennifer_mack{at}dfci.harvard.edu

Purpose Previous literature suggests that parents often wish to continue cancer-directed therapy for their children with incurable cancer. We assessed parents’ experiences with treatment for their children with cancer and no realistic chance of cure.

Patients and Methods We administered questionnaires to 141 parents of children with cancer who died after receiving care at one of two cancer centers. Parents were asked whether the child benefited and suffered from treatment administered after the parent recognized that cure was not a realistic expectation, and whether they would recommend cancer-directed therapy to other families of children with advanced cancer.

Results Fifty-three (38%) of 141 children received cancer-directed therapy after the parent recognized that the child had no realistic chance for cure. Most of these parents felt that their child had experienced at least some suffering resulting from the therapy (61%, 31 of 51) and little to no benefit (57%, 29 of 51). Fifty-one (38%) of 135 parents overall would recommend standard chemotherapy and 46 (33%) of 140 would recommend experimental chemotherapy to families of children with advanced cancer. Even parents who would not recommend standard chemotherapy generally felt the physician should offer it (91%, 88 of 97). Parents who reported that their children experienced suffering resulting from cancer-directed therapy (odds ratio = 0.46; P = .02) were less likely to recommend standard chemotherapy to other families.

Conclusion Although many parents choose treatment for their children with incurable cancer, bereaved parents often would not recommend such therapy. Parents who felt their children suffered as a result of cancer treatment were particularly unlikely to recommend it.

published online ahead of print at www.jco.org on September 8, 2008

Supported by Grant No. NCI 5 K07 CA 096746 from the National Cancer Institute (J.W) and a Career Development Award from the American Society of Clinical Oncology (J.W.M.).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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