1398P - Aggressiveness of care at the end of life in children with cancer - a nationwide cohort study

Date 10 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Cancers in Adolescents and Young Adults (AYA)
Palliative Care
Supportive and Palliative Care
Presenter Ana Cardoso
Citation Annals of Oncology (2017) 28 (suppl_5): v497-v501. 10.1093/annonc/mdx382
Authors A. Cardoso1, D. Martins Branco2, A. Lacerda2, B. Gomes3, S. Lopes4
  • 1Paediatric Department, Centro Hospitalar do Tâmega e Sousa, 4564 - Penafiel/PT
  • 2Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E. (IPOLFG EPE), 1099-023 - Lisbon/PT
  • 3Department Of Palliative Care, Policy And Rehabilitation, King’s College, Cicely Saunders Institute, WC2R 2LS - London/GB
  • 4Escola Nacional De Saúde Pública E Centro De Investigação Em Saúde Pública, Universidade NOVA de Lisboa, 1600 - Lisbon/PT



Cancer remains the leading medical cause of death in children. Ensuring quality of life should be a priority, but it may be difficult to stop treatments, particularly in settings where palliative care is scarce. Little is known about how many children dying from cancer experience aggressive care near the end of life (ACCEoL) in such settings (the most common worldwide). Our study aims to determine time trends in the prevalence of ACCEoL in this population.


Cohort study of children (0-17yo) who died with ICD-9-CM diagnosis of cancer in public hospitals in mainland Portugal (Jan’10 to Dec’15), identified from the Hospital Morbidity database. Based on previous studies and clinical experience, measures of ACCEoL comprised: in last 14 days of life: a) intravenous chemo/immunotherapy; in last 30 days of life: b) >14 days spent in hospital, c) >1 hospitalization, d) intensive care unit (ICU) admission, e) advanced life support (e.g. cardiopulmonary resuscitation), f) insertion of devices (e.g. central vascular access, CVA), g) total parenteral nutrition (TPN). We calculated prevalences and tested for time trends using chi2 for trend.


The study included 300 patients (median age 9 yo, IQR 4-14, 58.7% male). The prevalence of ACCEoL was stable over time, with 87.8% of the children experiencing at least one ACCEoL measure (85.2% in 2010, 88.4% in 2015; p = 0.816)). The most prevalent individual ACCEoL measures were >14 days spent in hospital (51.0%) and >1 hospitalization (43.3%). Most measures showed no statistically significant time trend.


In a setting in early stages of pediatric palliative care development, we found that eight in ten children dying from cancer experience ACcEoL in their last month of life. This estimate is higher than those found in countries in more advanced developmental stages and may indicate a need to increase paediatric palliative care availability. The findings also prompt healthcare professionals to reflect on their current practice, balancing treatments and hospitalisations with patients’ quality of life in the days they have to live.

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All authors have declared no conflicts of interest.