At the onset of Assistant Professor Kimberley Widger’s study, little was known about the impact specialized pediatric palliative care (SPPC) teams have on patterns of end-of-life care in children with cancer. Dr. Widger, Dr. Sumit Gupta from the Hospital for Sick Children & their research team sought to determine (1) which children with cancer access SPPC and (2) the impact of accessing SPPC on the risk of experiencing high-intensity end-of-life care.
Although cure rates for children with cancer continue to improve, approximately 20% die of their disease, many of whom undergo intensive medical treatment at the end-of-life. Using a provincial childhood cancer registry, the researchers assembled a retrospective cohort of Ontario children with cancer who died between 2000 and 2012 and received care through pediatric institutions with an SPPC team. They sought to determine if the integration of SPPC teams with oncology care could reduce high-intensity end-of-life care and associated suffering.
The study found that, when available, SPPC is associated with lower intensity care at the end of life for children with cancer. Unfortunately, children were less likely to receive SPPC if they had a hematologic cancer like leukemia, lived in low-income areas, or lived further away from the hospital. The study results provide the strongest evidence to date supporting the creation and timely involvement of SPPC teams to improve care for children with cancer. The study’s findings can be used to inform palliative care advocacy and policy efforts.
The research team previously published two related papers that examined trends in the intensity of end-of-life care for children with cancer and whether administrative data accurately identifies children who receive SPPC. The team held an end-of-grant meeting in October 2017 with interested stakeholders to discuss the results of all three studies and to identify the implications for clinical care, research, and policy. For more information please visit Dr. Widger’s website.
This work was supported by a Pitblado Discovery Grant from the Garron Family Cancer Centre at the Hospital for Sick Children and the Bloomberg Faculty Pilot Research Grant Program. The study was also supported by the Institute for Clinical Evaluative Sciences, funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.
Listen to the JCO podcast Understanding the ‘Value-Added’ by Specialized Pediatric Palliative Care Teams in the Care of Children With Cancer at the End of Life By Erica C. Kaye on Dr. Widger’s paper.