Current Status of Aggressive End-of-Life Care in Children with Hematologic Malignancy: A Population Based Study

Background: Hematologic malignancies are the most frequent type of cancer in children but limited data are available regarding the quality of end-of-life care (EOLC) for children with hematologic malignancies. The aims of this study were (i) to compare aggressive EOLC between children with hematologic malignancies and those with solid tumors; and (ii) to describe factors associated with aggressive EOLC in children with hematologic malignancies. Methods : We retrospectively reviewed 0- to 18-year-old patients with cancer, who died between April 2012 and March 2016 in Japan using the Diagnosis Procedure Combination per-diem payment system. Indicators of aggressive inpatient EOLC were defined as intensive care unit admission, cardiopulmonary resuscitation (CPR), intubation and/or mechanical ventilation, hemodialysis, or extra-corporeal membrane oxygenation in the last 30 days of life, or intravenous chemotherapy in the last 14 days. We determined factors associated with aggressive EOLC using regression models. Data regarding use of blood transfusion were also obtained from the database. Results: Among 1199 patients, 433 (36%) had hematological malignancies. Children with hematologic malignancies were significantly more likely than those with solid tumors to have intubation and/or mechanical ventilation (37.9% vs. 23.5%), intensive care unit admission (21.9% vs. 7.2%), CPR (14.5% vs. 7.7%), hemodialysis (13.2% vs. 3.1%) or extra-corporeal membrane oxygenation (2.5% vs. 0.4%) in their last 30 days, or intravenous chemotherapy (47.8% vs. 18.4%; all P < .01) within their last 14 days of life. Over 90% of children with hematological malignancies received a blood transfusion within the last 7 days of life. For hematological malignancies, age under 5 years was associated with CPR and ≥2 aggressive EOLC indicators. Longer hospital stays had decreased odds of ≥2 aggressive EOLC indicators. Conclusion: Children with hematologic malignancies are more likely to have aggressive EOLC compared to those with solid tumors. A younger age and shorter hospital stay might be associated with aggressive EOLC in children with hematologic malignancies.