Receipt of life-sustaining treatments for taiwanese pediatric patients who died of cancer in 2001 to 2010 a retrospective cohort study

Yen-Ni Hung, Tsang Wu Liu, Dong Tsamn Lin, Yueh Chih Chen, Jen Shi Chen, Siew Tzuh Tang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aggressive life-sustaining treatments have the potential to be continued beyond benefit, but have seldom been systematically/nationally explored in pediatric cancer patients. Furthermore, factors predisposing children dying of cancer to receive life-sustaining treatments at end of life (EOL) have never been investigated in a populationbased study. This population-based study explored determinants of receiving life-sustaining treatments in pediatric cancer patients' last month of life. For this retrospective cohort study, we used administrative data on 1603 Taiwanese pediatric cancer patients who died in 2001 to 2010. Individual patient-level data were linked with encrypted identification numbers from the National Register of Deaths Database, Cancer Registration System database, National Health Insurance claims datasets, and Database of Medical Care Institutions Status. Life-sustaining treatments included intensive care unit (ICU) care, cardiopulmonary resuscitation (CPR), and mechanical ventilation. Associations of patient, physician, hospital, and regional factors with receiving ICU care, CPR, and mechanical ventilation in the last month of life were evaluated by multilevel generalized linear mixed models. In their last month of life, 22.89%, 46.48%, and 61.45% of pediatric cancer patients received CPR, mechanical ventilation, and ICU care, respectively, with no significant decreasing trends from 2001 to 2010. Patients were more likely to receive all three identified life-sustaining treatments at EOL if they were diagnosed with a hematologic malignancy or a localized disease, died within 1 year of diagnosis, and received care from a pediatrician. Receipt of ICU care or mechanical ventilation increased with increasing EOL-care intensity of patients' primary hospital, whereas use of mechanical ventilation decreased with increasing quartile of hospice beds in the patients' primary hospital region. Taiwanese pediatric cancer patients received aggressive life-sustaining treatments in the month before death. Healthcare policies and interventions should aim to help pediatricians treating at-risk pediatric cancer patients and hospitals with a tendency to provide aggressive EOL treatments to avoid the expense of life-sustaining treatmentswhen chance of recovery is remote and to devote resources to care that produces the greatest benefits for children, parents, and society.

Original languageEnglish
Article numbere3461
JournalMedicine (United States)
Volume95
Issue number16
DOIs
Publication statusPublished - 2016

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Cohort Studies
Retrospective Studies
Pediatrics
Neoplasms
Artificial Respiration
Intensive Care Units
Therapeutics
Cardiopulmonary Resuscitation
Databases
Cancer Care Facilities
Hospices
Pediatric Hospitals
Terminal Care
National Health Programs
Hematologic Neoplasms
Causality
Linear Models
Parents
Delivery of Health Care
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Receipt of life-sustaining treatments for taiwanese pediatric patients who died of cancer in 2001 to 2010 a retrospective cohort study. / Hung, Yen-Ni; Liu, Tsang Wu; Lin, Dong Tsamn; Chen, Yueh Chih; Chen, Jen Shi; Tang, Siew Tzuh.

In: Medicine (United States), Vol. 95, No. 16, e3461, 2016.

Research output: Contribution to journalArticle

Hung, Yen-Ni ; Liu, Tsang Wu ; Lin, Dong Tsamn ; Chen, Yueh Chih ; Chen, Jen Shi ; Tang, Siew Tzuh. / Receipt of life-sustaining treatments for taiwanese pediatric patients who died of cancer in 2001 to 2010 a retrospective cohort study. In: Medicine (United States). 2016 ; Vol. 95, No. 16.
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