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Family Refusal of Chemotherapy for Pediatric Cancer Patients: A National Survey of Oncologists

Nassin, Michele L. MD*,†; Mueller, Emily L. MD, MSc; Ginder, Curt BS*,§; Kent, Paul M. MD*

Journal of Pediatric Hematology/Oncology: July 2015 - Volume 37 - Issue 5 - p 351–355
doi: 10.1097/MPH.0000000000000269
Original Articles

Background: Refusal of therapy is ethically acceptable for competent adults. Practitioner opinions regarding refusal of therapy in pediatric cancer patients has not been widely studied. This is the largest survey of oncology practitioners assessing support for refusal of chemotherapy.

Procedure: Pediatric oncology nurses/physicians were asked: “As their provider I would support refusal of chemotherapy by a family,” with the following options: “Never support refusal,” “Always support refusal,” or “Support for refusal would depend on cure rate, age, or both.” Variables assessed were: age (0 to 7, 8 to 13, 14 to 17 y) and cure rate (0% to 33%, 34% to 66%, 67% to 100%).

Results: A total of 957 practitioners responded. Fifty-six percent, 31%, and 0.2%, respectively, stated their support of chemotherapy refusal depended on “age and cure rate,” “cure rate alone,” or “age alone.” Two percent and 11% indicated they would “always” or “never” support refusal, respectively. For a “modest” or “good” cure rate, support for refusal was <20%, whereas for a “poor” cure rate, the majority would support a family’s refusal (53% to 78% age dependent). Within each cure rate, respondents were more likely to support refusal for older patients (P<0.001).

Conclusions: The majority of practitioners surveyed viewed parental refusal of chemotherapy for children with a moderate or good expected cure rate as unacceptable, but were more accepting of refusal with a poor prognosis, especially for teenagers.

*Department of Pediatrics, Rush University Medical Center

Department of Pediatrics, Section of Hematology/Oncology, University of Chicago

§University of Chicago Medical School, Chicago, IL

Department of Pediatrics, University of Michigan, Ann Arbor, MI

The authors declare no conflict of interest.

Reprints: Paul M. Kent, MD, Department of Pediatrics, RUSH University Medical Center, 1725 W Harrison St, Suite 710, Chicago, IL 60612 (e-mail: paul_kent@rush.edu).

Received April 30, 2014

Accepted September 4, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.