“Do-Not-Resuscitate” Orders in Children with Cancer at the End of Life: A Retrospective Review

‘‘Do-not-resuscitate’’ (DNR) orders constitute a vital part of End-of-Life (EOL) care for patients with terminal cancer. In this retrospective study, we reviewed the medical records of patients treated at a tertiary referral pediatric oncology unit between May 2006 and May 2017. We gathered data about days from signing the DNR to death, age at death, gender, disease and its status, place of death, and survival and performed t-test and χ2 test as appropriate. Of the 225 patients [127 males, 98 females; median age: 10.0 years (range, 0.4-23.4) years] enrolled, 130 (57.8%) provided DNR orders signed by their surrogates. In addition, 29.3%, 44.8%, and 25.8% of deaths occurred in the pediatric oncology ward, the intensive care unit, and at home or another hospital, respectively. We observed an annual increase in the signing rate of DNR orders. The median duration between signing a DNR order and death was 2 (range: 0-88) days. Furthermore, DNR orders tended to be committed by patients with slowly deteriorating disease and those with extended overall survival. This study deduces that an explicit DNR order is now a rule rather than an exception, with more DNR orders being signed for patients aged>10 years hospitalized for EOL cancer care. Hence, the early implementation of a DNR order could be underutilized in younger patients with cancer.