Current status of intensive end-of-life care in children with hematologic malignancy: a population-based study

BMC Palliative Care

卷:20

Motohiro Kato¹  Kimikazu Matsumoto¹  Kiyohide Fushimi²  Daisuke Shinjo³  Nobuyuki Yotani⁴  Yoshiyuki Kizawa⁵ 

[1] Children’s Cancer Center, National Centre for Child Health and Development;

[2] Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School;

[3] Department of Information Technology and Management, National Centre for Child Health and Development;

[4] Department of Palliative Medicine, National Centre for Child Health and Development;

[5] Kobe University Graduate School of Medicine;

关键词: Quality of life;    ICU admission;    Cardiopulmonary resuscitation;    Extra-corporeal membrane oxygenation;    Intravenous chemotherapy;    Mechanical ventilation;   

DOI  :  10.1186/s12904-021-00776-5

来源: DOAJ

【 摘 要 】

Abstract Background Adult patients with hematologic malignancies are less likely to receive palliative care and more likely to accept intensive anti-cancer treatments until end-of-life than those with solid tumors, but limited data are available regarding the quality of end-of-life care (EOLC) for children with hematologic malignancies. To improve the quality of EOLC for children with hematologic malignancies, the aims of this study were (i) to compare intensive EOLC between children with hematologic malignancies and those with solid tumors; and (ii) to describe factors associated with intensive EOLC in children with hematologic malignancies. Methods We retrospectively reviewed 0- to 18-year-old patients with cancer, who died in hospital between April 2012 and March 2016 in Japan using the Diagnosis Procedure Combination per-diem payment system. Indicators of intensive inpatient EOLC were defined as intensive care unit admission, cardiopulmonary resuscitation (CPR), intubation and/or mechanical ventilation, hemodialysis, or extra-corporeal membrane oxygenation in the last 30 days of life, or intravenous chemotherapy in the last 14 days. We determined factors associated with intensive EOLC using regression models. Data regarding use of blood transfusion were also obtained from the database. Results Among 1199 patients, 433 (36%) had hematological malignancies. Children with hematologic malignancies were significantly more likely than those with solid tumors to have intubation and/or mechanical ventilation (37.9% vs. 23.5%), intensive care unit admission (21.9% vs. 7.2%), CPR (14.5% vs. 7.7%), hemodialysis (13.2% vs. 3.1%) or extra-corporeal membrane oxygenation (2.5% vs. 0.4%) in their last 30 days, or intravenous chemotherapy (47.8% vs. 18.4%; all P < .01) within their last 14 days of life. Over 90% of children with hematological malignancies received a blood transfusion within the last 7 days of life. For hematological malignancies, age under 5 years was associated with CPR and ≥ 2 intensive EOLC indicators. Longer hospital stays had decreased odds of ≥ 2 intensive EOLC indicators. Conclusion Children with hematologic malignancies are more likely to receive intensive EOLC compared to those with solid tumors. A younger age and shorter hospital stay might be associated with intensive EOLC in children with hematologic malignancies.

【 授权许可】

Unknown