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

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-PPOn = 235; post-PPOn = 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.

Automated summary

The study found that an embedded pediatric palliative oncology clinic is associated with higher receipt of palliative care and less hospital days in the last 90 days of life for oncology patients with high-risk events. In the post-PPO cohort, patients received palliative care more often, received it earlier, and spent fewer days hospitalized in the last 90 days of life compared to the pre-PPO cohort. Continued improvements in these outcomes are expected with additional oncology provider education and personnel in the PPO clinic.