Describing Deaths over a Decade: The Final Week of Life Among Hospitalized Children with Cancer

Little is known about the final week of life for inpatient pediatric oncology patients. The purpose of this study was to describe inpatient pediatric oncology deaths.

Retrospective chart review of all patients who died in a large pediatric cancer center between 2007 and 2017. Demographic, diagnostic, and proximate cause of death information was extracted. Intensive care unit (ICU) admissions, chemotherapy receipt, medical interventions, and cardiopulmonary resuscitation (CPR) events one week, 48 h, and 24 h prior to death were obtained. Analysis included descriptive and statistical correlations.

344 decedent pediatric oncology patients were included. Half of the patients died in the ICU (51%). The average age was 11.3 years (range 0.13-27.7 years). Most had ongoing evidence of disease (86%) with 20% receiving cure-directed chemotherapy during their final week. Receiving cure-directed chemotherapy was not associated with age, race, ethnicity, or diagnosis but was associated with a significantly increased likelihood of receiving CPR on the last day of life (p = 0.011). The majority (84%) of children did not receive CPR on their final day of life. Receipt of CPR was not associated with race/ethnicity. CPR was associated with younger age (p = 0.006), hematologic malignancies (p = 0.037), and ICU location (p < 0.001). Most patients were not on dialysis (84%), pressors (72%), or ventilated (60%) during the final 24 h of life. Compassionate extubation occurred in <6% of deaths.

Most deaths in a pediatric cancer center occur in children with active disease. Continuation of cure-directed chemotherapy, age, diagnosis, and location of death has potential to influence end-of-life inpatient care.