“Children, adolescents, and young adults with hematologic malignancies tend to receive high-intensity end-of-life care (HI-EOLC), but sociodemographic and hospital-based predictors of HI-EOLC remain unclear,” wrote the study authors.
High-Intensity End of Life Care
For this retrospective population study, the researchers utilized the Premier Healthcare database to identify 1,454 patients with hematologic malignancies aged 0 to 39 years at death between 2010 and 2017. They defined HI-EOLC as receiving two or more of the following within 30 days of death: cardiopulmonary resuscitation, intravenous chemotherapy, hemodialysis, mechanical ventilation, tracheostomy placement, or an emergency department visit. To investigate the association between patient sociodemographic and hospital factors and HI-EOLC, they conducted multivariable logistic regression.
The data showed that more than half (55%) of patients identified received HI-EOLC within one month of death. Hospital size was found to be associated with end-of-life care. Patients treated in medium or large hospitals (adjusted odds ratio [aOR]=1.63 and 2.21, respectively) were more likely to receive intense care. Other factors associated with HI-EOLC were being insured by Medicare (aOR=1.40), or receiving cancer treatment in the Northeast US (aOR=1.50).
Clinical Takeaway for AYAs with Blood Cancer
In conclusion, the authors wrote, “A majority of children, adolescents, and young adults with hematologic malignancies experienced HI-EOLC, and the likelihood of HI-EOLC was influenced by the hospital size, type of insurance, and geographic region. Further research is needed to determine how to mitigate these risks.”
“Children and adolescents with hematologic malignancies consistently experience higher rates of aggressive care at the end of life. Clinicians and researchers must now turn their attention to reducing this disparity,” wrote Adam Rapoport MD, and Sumit Gupta MD, PhD, in an editorial about this data.