Children with cancer, particularly those with hematologic malignancies, continue to experience high-intensity medical care at the end of life (EOL), according to a study published in the Journal of Clinical Oncology.1

Pediatric patients with cancer often receive high-intensity EOL care. Because prior studies have been limited to single institutions or lacked detailed clinical data, researchers sought to conduct a retrospective cohort study to examine predictor of, and trends in, high-intensity EOL care.

For the study, investigators analyzed data from 815 patients with childhood cancer who died between 2000 and 2012 in Ontario, Canada. Data was compiled using a provincial cancer registry and linked to population-based health care data.

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High-intensity EOL care was defined as any of the following: intravenous chemotherapy less than 14 days from death; more than 1 emergency department visit; and more than 1 hospitalization or intensive care unit admission less than 30 days from death.

Results showed that 40.6% of patients received high-intensity care at the end of life. Researchers found that patients with hematologic malignancies were 2.5 times more likely to experience high-intensity EOL care compared with those with solid tumors (odds ratio [OR], 2.5; 95% CI, 1.8-3.6; P <.001).

The study further demonstrated that patients with hematologic malignancies and those who died after 2004 were more likely to receive the most invasive EOL care, such as admission to the intensive care unit or use of mechanical ventilation.

Analyses excluding cases of treatment-related mortality showed no substantial impact on the results.

The findings suggest that despite increased access to palliative care, the rates of the most invasive EOL care have increased over time. Therefore, future studies are needed to explore the relationship between high-quality palliative care and high-intensity EOL care, especially in vulnerable populations.


1. Kassam A, Sutradhar R, Widger K, et al. Predictors of and trends in high-intensity end-of-life care among children with cancer: A population-based study using health services data. J Clin Oncol. 2016 Nov 14. doi: 10.1200/JCO.2016.68.8283. [Epub ahead of print]