Procedural burden experienced by children with cancer during their terminal hospital admission
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In brief
In brief
This retrospective study of 2,210 pediatric cancer patients who died during hospital admission found that 64% underwent invasive procedures during their terminal stay, with 21% receiving major operations. Notably, over one-fifth of patients who had major surgery died within 48 hours, highlighting the need for multidisciplinary end-of-life discussions.
Written by the GCMD Library team from the article.
Background
Children with chronic conditions, including cancer, have been shown to have high-intensity end-of-life care. We assessed the frequency and timing of invasive procedures that children with cancer undergo during their terminal hospital admission (THA).
Methods
The Pediatric Health Information System database was queried from 2011 to 2015 for patients ages 1–18 years with a "malignancy" flag who died in the hospital. Patient demographics, admission details, procedures codes, and date of service were extracted. Invasive procedures were categorized into ‘major operations' or ‘minor procedures'.
Results
2210 children with cancer were identified as having a THA. During the THA, 1423 (64.4%) patients underwent an invasive procedure and 856 (60.1%) of those children underwent three or more procedures. 466 (21.1%) patients underwent a total of 780 major operations. The most common operations were ventriculostomy/ventriculoperitoneal shunt (n = 211), intracranial mass excision (n = 60), bowel resection (n = 56), and exploratory laparotomy/laparoscopy (n = 46). 101 (21.7%) patients who underwent a major operation died within 48 h of surgery.
Conclusions
Children who have cancer and die in the hospital face a large procedural burden prior to their death. This study highlights the need for open, multidisciplinary discussions regarding the necessity of these procedures and for surgeon involvement in complex end-of-life care decisions.
Type of study
Retrospective cohort review.
Level of evidence
Level IV.