End of life in a cross-cultural context - immigrant children with end-stage cancer

Introduction: Immigration phenomena in Spain have led to an increase in the immigrant pediatric population with cancer. Adequately caring for this terminally ill population requires actively paying attention to physical, psychic, social, and spiritual complaints in both patients and their families with consideration of their cultural peculiarities. Objective: To understand the medical and psychosocial characteristics of immigrant pediatric end-stage cancer patients, and to compare these to the Spanish population. Patients and method: Epidemiological, medical, and psychosocial variables were retrospectively collected by reviewing data in the medical and psychosocial history of immigrant cancer patients who died in 1995-2005. Results: A total of 27 immigrant children with cancer (mean age 9 +/- 4 years) died in our unit. Half of these patients were from Latin America, predominantly from Ecuador (29%). In all, 60% of demised patients had advanced disease at diagnosis. Blood malignancies were the most common cause of death. Our assessment of financial status, family structure, and patient behavior changes showed poorer results in the immigrant versus the Spanish population. Discussion: End-stage cancer in the immigrant pediatric population entails a high-vulnerability situation. A multidisciplinary team must provide personalized responses considering clinical, social, psychological, and spiritual factors. Transculturalization in our country demands that healthcare professionals palliate this vulnerability pyramid by using adequate, specific interdisciplinary interventions.