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One Last Summer

A Day of Reckoning
WebMD Feature
Reviewed by Craig H. Kliger, MD

Jan. 29, 2001 (Berkeley, Calif.) -- Gabriel Catalfo spent his summer doing what teenagers usually do. He hung out with friends. He went to camp. He scared the daylights out of his parents by going skydiving.

Then, that fall, he died.

Gabe's death, in November 1998, was no surprise. In fact, he had been dying all summer long, ever since tests in June revealed that his cancer had invaded his bone marrow.

Diagnosed with acute lymphocytic leukemia at age 7, by 15 Gabe already had undergone two rounds of intensive chemotherapy plus radiation. Neither punch seemed to faze the cancer. Within months of each, his leukemia was back.

A bone marrow transplant in August 1997 was Gabe's last, best hope. When he relapsed again the following June, so did any chance of beating cancer for good. At a time in medical history when three out of four children with cancer can be cured, the goal of Gabe's doctors and parents became agonizingly modest.

"They weren't trying to treat the disease in any kind of a meaningful way," says Phil Catalfo, Gabe's father. "They were trying to keep a lid on it, and they were trying to support him to have as decent a life as he could."

Yet Gabe lived longer and more richly than anyone imagined -- a full five months of jet-skiing, skydiving, and playing with his dog, until his weakened immune system gave way to a powerful fungus infection.

"Gabe had that kind of magnetic personality that everybody took a shine to," says Phil Catalfo. "He turned something on in people, and also he was so heroic in the way that he approached his treatment. Even with every setback, [the doctors] really felt they were going to save him." Until, one day, they couldn't.

Despite Higher Survival Rates, Some Suffer Too Much

Cases like Gabe's are drawing more attention to the increasing need for children's palliative care -- treatment aimed at easing the suffering of those with advanced or incurable disease.

In November, researchers at the Dana-Farber Cancer Institute in Boston published a study in the Journal of the American Medical Association based on a survey of parents of 103 children treated from 1990 to 1997 who died of cancer. The children ranged in age from 3 to 18 years of age; the average age at death was 11 years.

The study found that on average, physicians recognized there was "no realistic chance for cure" more than three months before parents did. However, when doctors and parents did agree on that fact early on, there were earlier discussions of hospice care, better parental ratings of the quality of home care their children received, and a higher likelihood that the focus turned to easing the child's suffering instead of aggressively treating the cancer.

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