Study Examines Racial Differences in Palliative Care for Childhood Cancers

A new study of palliative care in pediatric oncology has found that non-White children were more likely to die in the hospital than White patients, but that the difference was in concordance with the patients’ stated end-of-life goals.

The retrospective study explored patterns of pediatric palliative care (PPC) and health care utilization in 115 pediatric oncology patients (44 non-White patients). The primary outcomes were end-of-life patterns including timing of PPC consult, medical interventions in the last seven days of life, location of death, and resuscitation status at death.

“We identified no differences between White and non-White patients with regard to PPC patterns of care including frequency of PPC encounters or content of initial PPC consultation,” study authors noted.

There was a median of 12 PPC encounters before death, with the initial consult occurring a median of 3 months before death. These initial PPC consults were almost twice as likely to occur in an outpatient setting for White patients compared with non-White patients (49% vs. 25%).

Health care utilization during the last six months of life was similar regardless of race/ethnicity. However, location of death differed significantly. Non-White patients were more likely to die in-hospital compared with White patients (68% vs. 46%; P=0.03).

Thirty-nine percent of patients had documented preference for location of death available. In this cohort, non-White patients remained more likely to die in the hospital (64% vs. 29%). The location of death was concordant with expressed preference in the majority of patients in both groups.

“Although fewer non-White patients in our cohort preferred to die at home, all of those who expressed this preference successfully achieved goal-concordant location of death,” the researchers noted. “Further investigation exploring the factors that inform racial/ethnic differences in family goals for end-of-life care are clearly needed to ensure the provision of equitable and goal-concordant PPC.”