Specialized Pediatric Palliative Care Reduces High-Intensity Care at End of Life

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The effect of palliative care for pediatric patients has not been extensively researched.
The effect of palliative care for pediatric patients has not been extensively researched.

Pediatric patients with cancer who have access to specialized pediatric palliative care (SPPC) are less likely to receive high-intensity care at the end of life, according to a study published in the Journal of Clinical Oncology.

Previous studies have shown that palliative care among adults has led to less intensive treatments at the end of life — sparing patients significant suffering and exacerbations from aggressive therapies — but the effect of palliative care for pediatric patients has not been fully elucidated.

For this retrospective study, researchers accessed the Pediatric Oncology Group of Ontario Networked Information System (POGONIS) and reviewed the records of 572 patients who died and received care through pediatric institutions that had an SPPC team. Patients were categorized as having received SPPC, general palliative care, or no palliative care.

Analysis revealed that 166 (29%) patients received SPPC for at least 30 days prior to death compared with 100 (17.5%) patients who received general palliative care. The remaining 306 patients were categorized as receiving no palliative care.

Children with hematologic malignancies, children who lived further away from treatment centers, and children who lived in lower income neighborhoods were significantly less likely to receive care from an SPPC team.

SPPC care was associated with a 5-fold odds decrease in intensive care unit (ICU) admission among patients who received SPPC compared with those who received no palliative care. General palliative care did not change the odds of ICU admission compared with no palliative care.

SPPC was associated with significantly lower odds of receiving high-intensity end-of-life care compared with no palliative care.

The authors concluded that SPPC may lead to lower likelihood of high-intensity care at the end of life, but that “access to such care, however, remains uneven. In the absence of randomized trials, these results provide the strongest evidence to date supporting the creation of and timely involvement of SPPC teams and can be used to support [palliative care] advocacy and policy efforts.”

Reference

Widger K, Sutradhar R, Rapoport A, et al. Predictors of specialized pediatric palliative care involvement and impact on patterns of end-of-life care in children with cancer [published online January 22, 2018]. J Clin Oncol. doi: 10.1200/JCO.2017.75.6312

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