Specialized pediatric palliative care (SPPC) resulted in lower intensity end-of-life care for pediatric patients with cancer, although general palliative care (GPC) did not, according to research presented at the 2017 ASCO Annual Meeting (June 2-6, 2017; Chicago, IL).
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High-Intensity End-of-Life Care Common Among Pediatric Cancer Patients
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Despite the benefits associated with SPPC, access to such care remains elusive, results showed.
Children with cancer are frequently at risk for high-intensity care at the end of life, which is associated with high symptom burden and diminished quality of life. Few studies have examined generalized or specialty palliative care in this patient population.
Sumit Gupta, MD, PhD, FRCPC, staff oncologist and clinical investigator at The Hospital for Sick Children (Toronto, ON), and colleagues conducted a registry study to assess palliative care patterns among children who died of cancer between 2000 and 2012. Clinical palliative care databases identified patients who received SPPC at the end of life; other patients were categorized as having received GPC or no palliative care.
The study sought to determine whether receipt of SPPC reduced the risk for certain high-intensity end-of-life measures, such as intensive care unit (ICU) admission in the last 30 days of life; mechanical ventilation in the last 14 days of life; and in-hospital death.
The researchers identified several factors associated with a reduced likelihood of receiving SPPC, including a hematologic cancer diagnosis (odds ratio [OR] = 0.33; 95% CI, 0.3-0.37; P < .001); a family income in the lowest income quartile (OR = 0.44; 95% CI, 0.23-0.81; P = .009); and residing at an increased distance from a treatment center (OR = 0.46; 95% CI, 0.4-0.52; P < .0001).
The analysis showed a threefold decrease in ICU admissions at the end of life among patients who received SPPC (OR = 0.32; 95% CI, 0.18-0.57), although GPC had no discernable impact on end-of-life outcomes. Similar decreases were seen across all high-intensity end-of-life measures among patients receiving SPPC.
“In the absence of randomized trials, these results provide the strongest evidence to date supporting the creation of SPPC teams,” researchers wrote.—Cameron Kelsall
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