Predictors of Location of Death for Children with Cancer Enrolled on a Palliative Care Service

Abstract

Children with cancer who die in high-acuity inpatient settings often experience a high burden of intensive therapy at the end of life. Strategies to identify patients at higher risk of dying in the pediatric intensive care unit (PICU) have not been explored previously. This study finds that certain variables may predict PICU death for pediatric palliative oncology patients, including delayed palliative care involvement. Preemptive identification of patients at risk for PICU death affords opportunities to study the effects of earlier palliative care integration and increased discussions around preferred location of death on end-of-life outcomes for children with cancer and their families.

High‐intensity end‐of‐life care among children, adolescents, and young adults with cancer who die in the hospital: A population‐based study from the French national hospital database

“…Enrollment in a phase 1 trial was not associated with the timing of palliative care involvement before death, 55 nor was enrollment in a phase 1 trial associated with the location of death or the prioritization of quality of life at EOL. 13 Lastly, the rate of acute care hospital death (85%) was particularly high in comparison with previous studies (Taiwan, 74.3%-83.7% 18 ; England and Wales, 23-48% 56,57 ; United States, 41%-56% 7,58,59 ), questioning the ability of the French Health system to provide community palliative care. Studies have already reported that the proportion of home deaths remained lower in France than in other European or North American countries.…”

“…However, recent work suggests that patients who enroll in a phase 1 trial may be no more likely to die in high acuity settings than patients who receive standard therapy. Enrollment in a phase 1 trial was not associated with the timing of palliative care involvement before death, nor was enrollment in a phase 1 trial associated with the location of death or the prioritization of quality of life at EOL …”

“…Individuals with hematological malignancies and brain tumors were at higher risk of receiving aggressive care. This finding may be due in part to the pathophysiological nature of their disease processes . However, previous studies report that children with hematological malignancies suffer more from their last cancer therapy cycles, are less likely to be referred to palliative care teams, and have delayed anticipatory care planning .…”

“…This finding may be due in part to the pathophysiological nature of their disease processes. 13 However, previous studies report that children with hematological malignancies suffer more from their last cancer therapy cycles, are less likely to be referred to palliative care teams, and have delayed anticipatory care planning. [35][36][37] In contrast to solid tumors, which are less amenable to cure, hematological cancers are more often curable; therefore, .173…”

“…9,10 In contrast, the relevance of HI-EOL care in children, adolescents, and young adults is complex to analyze and depends largely on the clinical context in synergy with patient, family, and provider goals of care. 11 The receipt of HI-EOL care may carry both risks 7 and benefits [12][13][14] with regard to quality of life and the bereavement experience. To date, HI-EOL care is studied less often in children, adolescents, and young adults than in adults.…”