Predictors of Late Palliative Care Referral in Children With Cancer

Kaye, Erica C.; Jerkins, Jonathan; Gushue, Courtney; DeMarsh, Samantha; Sykes, April; Lu, Zhaohua; Snaman, Jennifer M.; Blazin, Lindsay; Johnson, Liza‐Marie; Levine, Deena R.; Morrison, R. Ray; Baker, Justin N.

doi:10.1016/j.jpainsymman.2018.01.021

Cited by 44 publications

(42 citation statements)

References 52 publications

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“…54 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, 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.…”

Section: Discussionmentioning

confidence: 93%

“…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 …”

Section: Discussionmentioning

confidence: 98%

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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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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 98%

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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“…Multiple studies have noted a short time between PC consultation and death, ranging from 42 to 223 days 1‐3,5,13,25 . Incorporating PC support late in a patient's course lessens its impact on quality of life, and instead may only impact the quality of death.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the recognition that early PC is beneficial in patients suffering from cancer, the most appropriate moment for PC introduction has been difficult to determine, often leading to delayed integration. PC introduction close to the EOL has limited ability to improve quality of life and parent distress 1,15 . Several studies have proposed ideas for earlier introduction of PC concepts, ranging from 2 days to 6 months after diagnosis 17‐21 .…”

Section: Introductionmentioning

confidence: 99%

Defining palliative opportunities in pediatric patients with bone and soft tissue sarcomas

Ebelhar

Allen

DeGroote

et al. 2020

Pediatric Blood & Cancer

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Background Pediatric patients with sarcomas experience significant morbidity and compromised quality of life throughout their course. These times could be viewed as opportunities for increased subspecialty palliative care (PC). Systematically defining opportunities for additional PC support has not occurred in pediatric oncology. The frequency, timing, and associated factors for palliative opportunities in pediatric patients with sarcomas are unknown. Methods A priori, nine palliative opportunities were defined (disease progression or relapse, admission for symptoms, social concerns or end‐of‐life, intensive care or bone marrow transplant admission, phase 1 trial or hospice enrollment, do‐not‐resuscitate status). A single‐center retrospective review was conducted on patients aged 0‐18 years with bone/soft tissue sarcomas who died from January 1, 2012 to November 30, 2017. Demographic, disease, and treatment data were collected. Descriptive statistics were performed. Opportunities were evaluated over quartiles from diagnosis to death. Results Patients (n = 60) had a mean of nine (SD = 4) palliative opportunities with the majority occurring in the last quartile of the disease course. Number and type of opportunities did not differ by demographics or diagnosis. Eighteen patients (30%) received PC consultation a median of 2.2 months (interquartile range [IQR] 11.5) prior to death. Consultation was unrelated to diagnosis or total opportunities. Conclusions Patients with sarcomas incur repeated events warranting subspecialty PC, which increase toward the end‐of‐life. Increased PC utilization may help decrease suffering and bolster family coping during these episodes. Additional work should further refine if opportunities differ across cancers, and how to incorporate this framework into clinical oncology care to prevent missed opportunities for PC.

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“…However, the fact that early PC referral is a predictor for location of death invariably begs the question: which factors predict early PC referral? Prior subanalysis of these data suggests that hematologic malignancy, cancer‐directed therapy at the end of life, and delayed advance directives documentation are associated with delayed PC involvement in children who died with cancer . Nonetheless, further investigation is needed to better elucidate predictors of delayed PC involvement in this patient population.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Predictors of Late Palliative Care Referral in Children With Cancer

Cited by 44 publications

References 52 publications

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

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

Defining palliative opportunities in pediatric patients with bone and soft tissue sarcomas

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

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