Patterns of medication use at end of life by pediatric inpatients with cancer

Abstract

Objective To describe medication utilization patterns by pediatric inpatients with cancer during their last week of life. Methods This retrospective study used data from the Vizient Clinical Database/Resource Manager, a national compilation of clinical and resource use data from over 100 academic medical centers and affiliates. Patients (0‐21 years) with malignancy who died during hospitalization (2010‐2017) were included (N = 1659). Medications were categorized as opioid, benzodiazepine, gastrointestinal related, chemotherapy, anti‐infectives, or vasopressors. Exposure to each group was ascertained for all patients at 1 week and 1 day prior to death. Factors associated with exposure were examined using generalized estimating equations, and summarized using adjusted odds ratios (aORs). Results Over the last week of life, there was increased use of opioids (76% to 82%, aOR = 1.55, P < .001) and benzodiazepines (53% to 66%, aOR = 1.36, P = .02), while gastrointestinal‐related medication use decreased (92% to 89%, aOR = 0.69, P = .001). Patients had decreased exposure to chemotherapy (10% to 5%, aOR = 0.46, P < .001) and anti‐infectives (82% to 73%, aOR = 0.41, P = .002). Vasopressor use increased as death approached (15% to 28%, aOR = 1.67, P = .04). Factors significantly associated with exposure varied with medication category, and included age, race, length of stay, malignancy type, death in the intensive care unit, history of hematopoietic stem cell transplant, and do‐not‐resuscitate status. Conclusion During the week preceding death, administration of symptom management medications increased for children with cancer, but use was not universal. Potentially life‐sustaining medications were often continued. Variability in utilization suggests differences in provider/family decision making that warrant further study to develop an evidence‐based approach to end‐of‐life care.

Practice patterns and real-life outcomes for patients with acute promyelocytic leukemia in the United States

“…The Vizient CDB contains inpatient and outpatient records from over 95% of academic medical centers and cancer specialty hospitals across the US, as well as 400 community hospital affiliates. 14,15 The database includes patient demographics; hospital characteristics; detailed (charge-level) data on accommodations, procedures, medication receipt; results for blood count and chemistry laboratory tests; and discharge timing and status. The study database was deidentified and without specific dates; resource use was reported relative to the admission date.…”