4232 - High intensity end-of-life care in pediatrics, adolescent and young adult patients with cancer using an administrative database.

Background

Pediatrics and AYA patients with cancer care often reported to receive high intensity medical care at the end-of-life. Especially, one study showed that Taiwanese children are more likely to receive high intensity care within one month from death than Canadian children. In this study, we investigate the current condition of end-of-life care for pediatrics, AYA patients who died at the hospital in Japan.

Methods

Using a multicenter administrative claims database, we identified patients with cancer aged 17 years or younger who died in hospital between July 2012 and March 2017 from 303 acute care hospitals in Japan. Patients’ data included age, gender, diagnosis, length of stay (LOS), use of opioids, the factors related to high-intensity end-of-life care (H-EOL), which comprised factors as follows; iv chemotherapy within 14 days from death, intensive care unit admission, more than one emergency department (ED) visit, more than 14 days hospital admission, and respiratory ventilation within one month from death.

Results

A total of 106 patients who died in 47 hospitals were included. The median age was 9 (0-17) years old and 57 patients (54%) were boys. Patients had brain tumor (n = 37), solid tumor (n = 30), hematologic malignancy (n = 25), other (n = 14). The average LOS was 60 (0-428 days). Fifty-five patients received opioids within 2weeks before their death. Ten patients received home medical care treatment before their death in the hospitals. Iv chemotherapy within 14 days from death was 25 patients (23.6%), intensive care unit admission within one month from death was 17 patients (16.0%), more than one ED visit within one month from death was 70 patients (66.0%), more than 14 days hospital admission was 69 patients (65.0%), and respiratory ventilation within one month from death was 20 patients (18.9%). Forty patients received one, 49 patients received two, 10 patients received three, 5 patients received four H-EOL care factors, respectively. Totally, 98% of patients had at least one H-EOL care factor.

Conclusions

Our study clarified the current situation of end-of-life care in the field of pediatrics, AYA with cancer. The proportion of H-EOL care in Japan is similar to that in Taiwan, and higher compared with that in Canada.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.