Pediatric inpatients with cancer may be overexposed to a number of medications in their last week of life; however, symptoms may still not be well managed despite the continue medication use, according to study results published in Pediatric Blood & Cancer. In addition, findings suggested that these medication patterns are not universal in this patient population.

Throughout the last several decades, survival rates among pediatric patients with cancer have significantly improved; however, approximately 2000 children and adolescents in the US die from cancer each year. While more than half of patients with terminal illness receive end-of-life care in the inpatient setting, many report dissatisfaction with management of disease symptoms.

As adults with terminal cancer receive a wide range of treatments in the final weeks and months of life, it is important to determine whether similar variance exists in treatment-decision making in the pediatric population. Researchers conducted a retrospective study to “fill the knowledge gap by describing patterns of medication use at end of life among pediatric inpatients with cancer using a large, multi-institution dataset.”

A total of 1659 patients who died during hospitalization between 2010 and 2017 were included in the analysis. The mean patient age was 13 years (range, 0-21), 729 (43.9%) were female, 880 (53.0%) were White, and the mean length of stay was 39 days. The majority (69.5%) died in the intensive care unit.


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During a patient’s last several days of life, patients used an average of 15 medications on a daily basis. The use of opioids increased during this period (from 76% to 82%; adjusted odds ratio [aOR], 1.55; P <.001), as did the use of benzodiazepines (from 53% to 66%; aOR, 1.36; P =.02) and vasopressors (from 15% to 28%; aOR, 1.67; P =.04).

The use of medications related to gastrointestinal issues decreased from 92% to 89% (aOR, 0.69; P =.001), as did exposure to chemotherapy (from 10% to 5%; aOR, 0.46; P <.001) and anti-infectives (from 81% to 73%; aOR, .41; P =.002).

Patient age, race, length of hospital stay, and type of malignancy were each associated with variance in treatment increases and decreases.

“Findings from this work suggest underutilization of symptom management medications or overexposure to other potentially life-sustaining medications may be contributing to poor symptom control,” the authors wrote.

“Further studies are needed to assess patient/parent and provider preferences regarding medication use at end of life and to create an evidence-based approach to care, improving the quality of life for children with cancer,” concluded the investigators.

Disclosure: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.

Reference

Prozora S, Shabanova V, Ananth P, et al. Patterns of medication use at end of life by pediatric inpatients with cancer. Pediatr Blood Cancer. Published online December 11, 2020. doi:10.1002/pbc.28837