Classification of treatment-related mortality in children with cancer: a systematic assessment

Alexander, Sarah; Pole, Jason D.; Gibson, Paul; Lee, Michelle; Hesser, Tanya; Susan, N.; Dvorak, Christopher C.; Fisher, Brian T.; Hasle, Henrik; Kanerva, Jukka; Möricke, Anja; Phillips, Bob; Raetz, Elizabeth A.; Rodríguez‐Galindo, Carlos; Samarasinghe, Sujith; Schmiegelow, Kjeld; Tissing, Wim J. E.; Lehrnbecher, Thomas; Sung, Lillian

doi:10.1016/s1470-2045(15)00197-7

Cited by 76 publications

(85 citation statements)

References 20 publications

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“…Our cumulative incidences of death in CR1 are similar to those reported by other study groups in overlapping time periods . However, comparing TRM rates is cumbersome due to the lack of uniformly used definitions . Because we defined TRM as death in CR1, patients who died in early stages of the treatment as a result of toxicity, but before achieving CR “by definition”, are not included in this number.…”

Section: Discussionmentioning

confidence: 95%

“…Because we defined TRM as death in CR1, patients who died in early stages of the treatment as a result of toxicity, but before achieving CR “by definition”, are not included in this number. Subsequently, this might be an underestimation compared with other reported TRM rates that include patients with just absence of progressive disease at time of death . A very recent study reported that TRM, defined as death in the absence of progressive disease, accounts for more than half of all deaths in Dutch pediatric patients with hematological malignancies …”

Section: Discussionmentioning

confidence: 95%

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Causes of early death and treatment‐related death in newly diagnosed pediatric acute myeloid leukemia: Recent experiences of the Dutch Childhood Oncology Group

Klein

Litsenburg

Haas

et al. 2019

Pediatric Blood & Cancer

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Background With the current more effective treatment regimens for pediatric acute myeloid leukemia (AML), research on early death (ED), treatment‐related mortality (TRM), and toxicity becomes increasingly important. The aim of this study was to give an overview of the frequency, clinical features, and risk factors associated with ED and TRM in first complete remission (CR1) during the last three consecutive treatment protocols of the Dutch Childhood Oncology Group (DCOG) between 1998 and 2014. Methods Incidence and risk factors associated with ED and TRM in CR1 were retrospectively studied in 245 patients treated according to the Dutch ANLL‐97/AML‐12 (n = 118), AML‐15 (n = 60), or DB AML‐01 (n = 67) protocols. Results The incidence of ED was, respectively, 5.1%, 6.7%, and 3.0% excluding deaths before treatment (P = NS), and 7.4%, 11.1%, and 4.4% including deaths before the onset of treatment. Severe underweight at initial diagnosis was significantly associated with more frequent ED. When relapse was included as a competing risk, cumulative incidence of death in CR1 were 5.9%, 5.0%, and 4.6% for ANLL97, AML15, and DB01, respectively (P = NS). The most important cause of TRM included infectious and SCT‐related complications. Conclusion We report relatively stable rates of ED and TRM in CR1 in the latest completed DCOG protocols for newly diagnosed AML patients. The most important causes of TRM were SCT‐ or infection‐related, warranting further evaluation and awareness.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Causes of early death and treatment‐related death in newly diagnosed pediatric acute myeloid leukemia: Recent experiences of the Dutch Childhood Oncology Group

Klein

Litsenburg

Haas

et al. 2019

Pediatric Blood & Cancer

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“…Because administrative data do not permit the capture of all of the complexity of palliative care, our indicators of HI‐EOL and MI‐EOL care may not be relevant for all individual situations. In our study, we were unable to identify and exclude patients who died of treatment‐related mortality (ie , “the absence of progressive disease at the time of death” according to Alexander et al). Thus, some deaths were unplanned, and active therapy was warranted until the time of death.…”

Section: Discussionmentioning

confidence: 99%

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

Revon‐Rivière

Pauly

Baumstarck

et al. 2019

Cancer

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Background Efforts to improve the quality of end‐of‐life (EOL) care depend on better knowledge of the care that children, adolescents, and young adults with cancer receive, including high‐intensity EOL (HI‐EOL) care. The objective was to assess the rates of HI‐EOL care in this population and to determine patient‐ and hospital‐related predictors of HI‐EOL from the French national hospital database. Methods This was a population‐based, retrospective study of a cohort of patients aged 0 to 25 years at the time of death who died at hospital as a result of cancer in France between 2014 and 2016. The primary outcome was HI‐EOL care, defined as the occurrence of ≥1 chemotherapy session <14 days from death, receiving care in an intensive care unit ≥1 time, >1 emergency room admission, and >1 hospitalization in an acute care unit in the last 30 days of life. Results The study included 1899 individuals from 345 hospitals; 61.4% experienced HI‐EOL care. HI‐EOL was increased with social disadvantage (adjusted odds ratio [AOR], 1.30; 95% confidence interval [CI], 1.03‐1.65; P = .028), hematological malignancies (AOR, 2.09; 95% CI, 1.57‐2.77; P < .001), complex chronic conditions (AOR, 1.60; 95% CI, 1.23‐2.09; P = .001) and care delivered in a specialty center (AOR, 1.70; 95% CI, 1.22‐2.36; P = .001). HI‐EOL was reduced in cases of palliative care (AOR, 0.31; 95% CI, 0.24‐0.41; P < .001). Conclusion A majority of children, adolescents, and young adults experience HI‐EOL care. Several features (eg, social disadvantage, cancer diagnosis, complex chronic conditions, and specialty center care) were associated with HI‐EOL care. These findings should now be discussed with patients, families, and professionals to define the optimal EOL.

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“…ED was defined as death during Ind I. EFS and OS were measured from study entry, and disease-free survival (DFS), TRM, 22 and RR were measured from the end of Ind I, for patients in CR. Patients lost to follow-up were censored at their last known contact.…”

mentioning

confidence: 99%

Gemtuzumab ozogamicin in infants with AML: results from the Children’s Oncology Group trials AAML03P1 and AAML0531

Guest

Aplenc

Sung

et al. 2017

Blood

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Classification of treatment-related mortality in children with cancer: a systematic assessment

Cited by 76 publications

References 20 publications

Causes of early death and treatment‐related death in newly diagnosed pediatric acute myeloid leukemia: Recent experiences of the Dutch Childhood Oncology Group

Causes of early death and treatment‐related death in newly diagnosed pediatric acute myeloid leukemia: Recent experiences of the Dutch Childhood Oncology Group

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

Gemtuzumab ozogamicin in infants with AML: results from the Children’s Oncology Group trials AAML03P1 and AAML0531

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