423 - Healthcare Utilization of Pediatric Patients with Cancer Near End-of-Life

Cancer is the third leading cause of pediatric deaths in the United States. Hospice and palliative care are important options for patients near end-of-life. There is growing evidence about the value of hospice and palliative care in the adult population, but data is lacking for pediatric patients. Detailing healthcare utilization and describing the hospice experience is important for both providers and families.


Objective:

To describe the healthcare utilization of pediatric patients with cancer in their last 60 days of life who died on hospice care compared to those who did not receive hospice care and died in the hospital.


Design/Methods: A retrospective cohort study was conducted using information from a pediatric palliative care database of deceased patients at a large academic center in 2020 and 2021. Inclusion criteria were patients receiving a palliative care consult with a cancer diagnosis who ultimately died in 2020 or 2021. Health information from each patient’s last 60 days of life was reviewed, comparing patients who died under hospice care to those who died in the hospital.

Results:

A total of 59 patients were included. 39 patients died at home and 20 died in the hospital. There was no statistical difference in the two groups in regards to age, age at diagnosis, race, gender, or insurance type. Patients who died under hospice care spent fewer days in the hospital in their last 60 days of life (2 days vs 30.5 days), including in the ICU (0 days vs 10.5 days).  In addition the hospice group were less likely to undergo medical procedures requiring anesthesia (0 vs 3.5) and spent less days utilizing mechanical ventilation (0 days vs 3.5 days). The average number of days spent at home on hospice was 44 days. There was also significantly fewer days between consult and death in the non-hospice group (80 days vs 451 days). 


Conclusion(s):

There are many known benefits of hospice and palliative care, including the possibility of spending more time at home near end of life. Patients who enter hospice care are less likely to undergo invasive procedures near the end of life and spend less time in the ICU. Further, many patients on average spend over a month living at home while receiving hospice care.  Earlier palliative care consult correlates to home hospice care, but further study is needed to determine if there is cause.