Palliative Care in SMA Type 1: A Prospective Multicenter French Study Based on Parents' Reports

Frontiers in Pediatrics

article

Marie Hully¹  Claude Cances³  Carole Vuillerot⁴  Caroline Espil⁵  Michele Mayer⁶  Marie-Christine Nougues⁶  Pascal Sabouraud⁷  Jeremie Lefranc⁸  Vincent Laugel⁹  Francois Rivier^1,10  Ulrike Walther Louvier^1,10  Christine Barnerias¹  Julien Durigneux^1,11  Sylvia Napuri^1,12  Catherine Sarret⁷  Michel Renouil^1,13  Alice Masurel^1,14  Marcel-Louis Viallard¹  Isabelle Desguerre¹  Delphine Chabalier¹  Sophie Le Guen^1,16  Virginie Germa²  Elodie Deladriere²  Catherine Vanhulle^1,17  Jean-Marie Cuisset^1,18  Brigitte Chabrol^1,19 

[1] Pediatric Neurology Department, Necker–Enfants Malades Hospital;Physical Rehabilitation Department, Necker–Enfants Malades Hospital;Pediatric Neurology Department, Enfants Hospital;Pediatric Physical Rehabilitation Department, Femme Mère Enfants Hospital;Pediatric Neurology Department, Pellegrin Hospital;Pediatric Neurology Department, Armand Trousseau Hospital;Pediatric Department, American Memorial Hospital;Pediatric Neurology Department, Morvan Hospital;Pediatric Neurology Department, Hautepierre Hospital;Pediatric Neurology Department & Neuromuscular Diseases Reference Center AOC, University of Montpellier;Pediatric Neurology Department, University Hospital;Pediatric Department, South Hospital;Pediatric Department, St-Pierre Hospital;Genetic Department, Children Hospital;Research Team “ETRES”, Université de Paris;Clinical Research Department, Necker–Enfants Malades Hospital;Neonatal Department, Charles Nicolle Hospital;Pediatric Neurology Department and Neuromuscular Diseases Reference Center;Pediatric Neurology Department, La Timone Hospital

关键词: SMA;    palliative care;    caregivers;    ethics;    standard of care;   

DOI  :  10.3389/fped.2020.00004

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Spinal muscular atrophy type 1 (SMA-1) is a severe neurodegenerative disorder, which in the absence of curative treatment, leads to death before 1 year of age in most cases. Caring for these short-lived and severely impaired infants requires palliative management. New drugs (nusinersen) have recently been developed that may modify SMA-1 natural history and thus raise ethical concerns about the appropriate level of care for patients. The national Hospital Clinical Research Program (PHRC) called “Assessment of clinical practices of palliative care in children with Spinal Muscular Atrophy Type 1 (SMA-1)” was a multicenter prospective study conducted in France between 2012 and 2016 to report palliative practices in SMA-1 in real life through prospective caregivers' reports about their infants' management. Thirty-nine patients were included in the prospective PHRC (17 centers). We also studied retrospective data regarding management of 43 other SMA-1 patients (18 centers) over the same period, including seven treated with nusinersen, in comparison with historical data from 222 patients previously published over two periods of 10 years (1989–2009). In the latest period studied, median age at diagnosis was 3 months [0.6–10.4]. Seventy-seven patients died at a median 6 months of age[1–27]: 32% at home and 8% in an intensive care unit. Eighty-five percent of patients received enteral nutrition, some through a gastrostomy (6%). Sixteen percent had a non-invasive ventilation (NIV). Seventy-seven percent received sedative treatment at the time of death. Over time, palliative management occurred more frequently at home with increased levels of technical supportive care (enteral nutrition, oxygenotherapy, and analgesic and sedative treatments). No statistical difference was found between the prospective and retrospective patients for the last period. However, significant differences were found between patients treated with nusinersen vs. those untreated. Our data confirm that palliative care is essential in management of SMA-1 patients and that parents are extensively involved in everyday patient care. Our data suggest that nusinersen treatment was accompanied by significantly more invasive supportive care, indicating that a re-examination of standard clinical practices should explicitly consider what treatment pathways are in infants' and caregivers' best interest. This study was registered on clinicaltrials.gov under the reference {"type":"clinical-trial","attrs":{"text":"NCT01862042","term_id":"NCT01862042"}} NCT01862042 (https://clinicaltrials.gov/ct2/show/study/ {"type":"clinical-trial","attrs":{"text":"NCT01862042","term_id":"NCT01862042"}} NCT01862042 ?cond=SMA1&rank=8).

【 授权许可】

CC BY