{"id":6417,"date":"2016-11-14T00:00:00","date_gmt":"2016-11-14T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/predictors-of-and-trends-in-high-intensity-end-of-life-care-among-children-with-cancer-a-population-based-study-using-health-services-data\/"},"modified":"2023-06-14T19:36:37","modified_gmt":"2023-06-14T23:36:37","slug":"predictors-of-and-trends-in-high-intensity-end-of-life-care-among-children-with-cancer-a-population-based-study-using-health-services-data","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/predictors-of-and-trends-in-high-intensity-end-of-life-care-among-children-with-cancer-a-population-based-study-using-health-services-data\/","title":{"rendered":"Predictors of and trends in high-intensity end-of-life care among children with cancer: a population-based study using health services data"},"content":{"rendered":"<p><strong>Purpose <\/strong>&#x2014; Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). Previous studies have been limited to single centers or lacked detailed clinical data. We determined predictors of and trends in HI-EOL care by linking population-based clinical and health services databases. <\/p>\n<p><strong>Methods<\/strong>&#xa0;&#x2014; retrospective decedent cohort of childhood cancer patients who died 2000-2012 in Ontario, Canada was assembled using a provincial cancer registry and linked to population-based healthcare data. Based on previous studies, the primary composite measure of HI-EOL care comprised any of: IV chemotherapy &lt;14 days from death; &gt;1 ED visit, &gt;1 hospitalization, or intensive care unit (ICU) admission &lt;30 days from death. Secondary measures included the individual measures above and measures of the most invasive (MI) EOL care [e.g. mechanical ventilation (MV) &lt;14 days from death]. We determined predictors of outcomes with appropriate regression models. Sensitivity analysis was restricted to cases of cancer related mortality, excluding treatment related mortality (TRM) cases. <\/p>\n<p><strong>Results <\/strong>&#x2014; 815 patients were included. 331 (40.6%) experienced HI-EOL care; those with hematologic malignancies were at highest risk [odds ratio (OR) 2.5, 95th confidence interval 1.8-3.6; p&lt;0.001)]. Patients with hematologic cancers, and those who died after 2004 were more likely to experience the MI-EOL care (e.g. ICU, MV; ORs from 2.0-5.1). Excluding cases of TRM did not substantively change the results. <\/p>\n<p><strong>Conclusions<\/strong> &#x2014; Ontario children with cancer continue to experience HI-EOL care. Patients with hematologic malignancies are at highest risk even when excluding TRM. Worryingly, rates of the MI-EOL care have increased over time despite increased palliative care access. Linking health services and clinical data allows monitoring of 3 population trends in EOL care and identifies high-risk populations for future interventions.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Purpose &#x2014; Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). Previous studies have been limited to single centers or lacked detailed clinical data. We determined predictors of and trends in HI-EOL care by linking population-based clinical and health services databases. Methods&#xa0;&#x2014; retrospective decedent cohort of childhood cancer patients who died [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[38,33,27],"migration-helper-qa-sample-set":[],"class_list":["post-6417","journal_article","type-journal_article","status-publish","hentry","topic-cancer-and-cancer-screening","topic-end-of-life-care","topic-pediatrics"],"acf":{"citation":"Kassam A, Sutradhar R, Widger K, Rapoport A, Pole JD, Nelson K, Wolfe J, Earle CC, Gupta S. <em>J Clin Oncol.<\/em> 2017; 35(2):236-42. Epub 2016 Nov 16.","source_url":"","ices_scientist":[1370,1098,1225,1239,1300,1129],"site":[6733],"research_program":[6741],"news_release":[7650],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"5E9B5635-8BFC-4536-8B8E-53ADF330F1B4","sitecore_item_name":"Predictors-of-and-trends-in-high-intensity-end-of-life-care-among-children-with-cancer","sitecore_field_values":"{\n  \"__Valid from\": \"20161208T133400\",\n  \"Title\": \"Predictors of and trends in high-intensity end-of-life care among children with cancer: a population-based study using health services data\",\n  \"Short title\": \"Predictors of and trends in\",\n  \"Summary\": \"Ontario children with cancer continue to experience high-intensity end-of-life care.\",\n  \"Citation\": \"<p>Kassam A, Sutradhar R, Widger K, Rapoport A, Pole JD, Nelson K, Wolfe J, Earle CC, Gupta S. <em>J Clin Oncol.<\/em> 2017; 35(2):236-42. Epub 2016 Nov 16.<\/p>\",\n  \"Abstract\": \"<p><strong>Purpose <\/strong>&mdash; Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). Previous studies have been limited to single centers or lacked detailed clinical data. We determined predictors of and trends in HI-EOL care by linking population-based clinical and health services databases. <\/p>rn<p><strong>Methods<\/strong>&nbsp;&mdash; retrospective decedent cohort of childhood cancer patients who died 2000-2012 in Ontario, Canada was assembled using a provincial cancer registry and linked to population-based healthcare data. Based on previous studies, the primary composite measure of HI-EOL care comprised any of: IV chemotherapy &lt;14 days from death; &gt;1 ED visit, &gt;1 hospitalization, or intensive care unit (ICU) admission &lt;30 days from death. Secondary measures included the individual measures above and measures of the most invasive (MI) EOL care [e.g. mechanical ventilation (MV) &lt;14 days from death]. We determined predictors of outcomes with appropriate regression models. Sensitivity analysis was restricted to cases of cancer related mortality, excluding treatment related mortality (TRM) cases. <\/p>rn<p><strong>Results <\/strong>&mdash; 815 patients were included. 331 (40.6%) experienced HI-EOL care; those with hematologic malignancies were at highest risk [odds ratio (OR) 2.5, 95th confidence interval 1.8-3.6; p&lt;0.001)]. Patients with hematologic cancers, and those who died after 2004 were more likely to experience the MI-EOL care (e.g. ICU, MV; ORs from 2.0-5.1). Excluding cases of TRM did not substantively change the results. <\/p>rn<p><strong>Conclusions<\/strong> &mdash; Ontario children with cancer continue to experience HI-EOL care. Patients with hematologic malignancies are at highest risk even when excluding TRM. Worryingly, rates of the MI-EOL care have increased over time despite increased palliative care access. Linking health services and clinical data allows monitoring of 3 population trends in EOL care and identifies high-risk populations for future interventions.<\/p>\",\n  \"Keywords\": \"{4F321D0E-F7F1-4C8D-B2FE-922AD8DE3C78}|{6F47479A-93B4-40A0-A72C-7D6B55EEC91A}|{3520E276-FC47-4BE8-BC0D-5FD075E6DBEF}\",\n  \"Related Products\": \"<h2>News release<\/h2>rn<h3><a href=\"~\/link.aspx?_id=83B69872B9CF4151BCC07843556D9EDF&amp;_z=z\">Children with cancer much more likely than adults to receive high-intensity end-of-life care despite access to palliative care<\/a><\/h3>rn<h2>ICES IN THE NEWS<\/h2>rn<h3><a href=\"http:\/\/www.healio.com\/hematology-oncology\/palliative-care\/news\/in-the-journals\/%7Be14335b7-7f30-4741-a45a-1b14580bad2e%7D\/children-with-cancer-often-receive-high-intensity-end-of-life-care\" title=\"Healio\" target=\"_blank\">Children with cancer often receive high-intensity end-of-life care<\/a><\/h3>\",\n  \"Research Programs\": \"{85DE96A6-4C96-40C7-8E6D-7597A0EB5F80}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{56BF24FA-D81E-4114-BF1F-4715A424E26C}|{F5F3AB6E-CD96-4F14-BDD6-206C43AC2DD3}|{B3A5A166-8F3C-43DC-8214-EFB653814F22}|{92701820-E853-436C-8AD9-173545BA0A7D}|{DEE749E0-0E36-4663-823A-67B486867148}|{E0A29C05-9BD7-4023-ACE7-3C3DF0559C1B}\",\n  \"Posted Date\": \"20161114T133800\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2016\/January\/Predictors-of-and-trends-in-high-intensity-end-of-life-care-among-children-with-cancer"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Predictors of and trends in high-intensity end-of-life care among children with cancer: a population-based study using health services data<\/title>\n<meta name=\"description\" content=\"Purpose &#x2014; Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). 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