Pediatric Anesthesiology 2006 PBL Pain and Symptom Management at the End of Life in a 14 Year-old with Osteosarcoma

1. Be aware of the causes and degree of suffering experienced by children dying of cancer. 2. Describe treatment for cancer pain, including dealing with common side effects. 3. Understand and discuss options for severe, rapidly escalating pain from tumor metastases that compress or infiltrate nervous structures in the terminally ill child. 4. Understand and role-play a discussion of end of life care with the parents of a child who is dying with painful metastases, dyspnea, fatigue, nausea and anorexia or other symptoms. 5. Understand the ethical principle of double effect and how it might apply in a dying patient. John is a fourteen year-old boy who has been treated at to your hospital for osteosarcoma in the right distal femur. After his initial chemotherapy, John had a limb sparring procedure and has also had two thoracotomies to resect pulmonary nodules. He had seemed to be doing well, but after eighteen months John has returned complaining of fatigue and low back pain radiating down his left leg. He is found to have widespread metastases. He again ha