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Author Notes:

katharine.brock@choa.org

Study conception and design were performed by Katharine Brock and Karen Wasilewski-Masker.

Material preparation and data collection were performed by Katharine Brock, Kristen Allen, Erin Falk, and Cristina Velozzi-Averhoff.

Data analysis was performed by Katharine Brock and Kristen Allen.

The first draft of the manuscript was written by Katharine Brock and all authors commented on previous versions of the manuscript.

All authors read and approved the final manuscript.

The authors would like to thank the Aflac Cancer & Blood Disorders Center for their programmatic contributions and patient/family referrals to Supportive Care Clinic, the Children’s Healthcare of Atlanta Pediatric Advanced Care Team, Kelly Yara, RN, Stacey Howard, RN, Georgia hospice providers, and most importantly the patients and families.

The authors declare that they have no conflict of interest.

Subjects:

Research Funding:

This study was funded by a Collaborative Pediatric Cancer Research Award and the Rally Foundation for Childhood Cancer.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Health Care Sciences & Services
  • Rehabilitation
  • Pediatric palliative care
  • Pediatric oncology
  • Supportive care
  • End-of-life
  • OF-LIFE CARE
  • EARLY INTEGRATION
  • END
  • OUTPATIENT
  • STANDARD
  • MODELS
  • TRENDS
  • IMPACT
  • HOME

Association of a pediatric palliative oncology clinic on palliative care access, timing and location of care for children with cancer

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Journal Title:

Supportive Care in Cancer

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Type of Work:

Article | Final Publisher PDF

Abstract:

Background: Most pediatric palliative care (PPC) services are inpatient consultation services and do not reach patients and families in the outpatient and home settings, where a vast majority of oncology care occurs. We explored whether an embedded pediatric palliative oncology (PPO) clinic is associated with receipt and timing of PPC and hospital days in the last 90 days of life. Methods: Oncology patients (ages 0–25) with a high-risk event (death, relapse/progression, and/or phase I/II clinical trial enrollment) between 07/01/2015 and 06/30/2018 were included. PPO clinic started July 2017. Two cohorts were defined: pre-PPO (high-risk event(s) occurring 07/01/2015–06/30/2017) and post-PPO (high-risk event(s) occurring 07/01/2017–06/30/2018). Descriptive statistics were performed; demographic, disease course, and outcomes variables across cohorts were compared. Results: A total of 426 patients were included (pre-PPO n = 235; post-PPO n = 191). Forty-seven patients with events in both pre- and post-PPO cohorts were included in the post-PPO cohort. Mean age at diagnosis was 8 years. Diagnoses were evenly distributed among solid tumors, brain tumors, and leukemia/lymphoma. Post-PPO cohort patients received PPC more often (45.6% vs. 21.3%, p < 0.0001), for a longer time before death than the pre-PPO cohort (median 88 vs. 32 days, p = 0.027), and spent fewer days hospitalized in the last 90 days of life (median 3 vs. 8 days, p = 0.0084). Conclusion: A limited-day, embedded PPO clinic was associated with receipt of PPC and spending more time at home in patients with cancer who had high-risk events. Continued improvements to these outcomes would be expected with additional oncology provider education and PPO personnel.

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© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.

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