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Patterns of medication use at end of life by pediatric inpatients with cancer
Author(s) -
Prozora Stephanie,
Shabanova Veronika,
Ananth Prasanna,
Pashankar Farzana,
Kupfer Gary M.,
Massaro Stephanie A.,
Davidoff Amy J.
Publication year - 2021
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28837
Subject(s) - medicine , malignancy , cancer , retrospective cohort study , odds ratio , chemotherapy , resource use , emergency medicine , pediatrics , intensive care medicine , economics , natural resource economics
Objective To describe medication utilization patterns by pediatric inpatients with cancer during their last week of life. Methods This retrospective study used data from the Vizient Clinical Database/Resource Manager, a national compilation of clinical and resource use data from over 100 academic medical centers and affiliates. Patients (0‐21 years) with malignancy who died during hospitalization (2010‐2017) were included (N = 1659). Medications were categorized as opioid, benzodiazepine, gastrointestinal related, chemotherapy, anti‐infectives, or vasopressors. Exposure to each group was ascertained for all patients at 1 week and 1 day prior to death. Factors associated with exposure were examined using generalized estimating equations, and summarized using adjusted odds ratios (aORs). Results Over the last week of life, there was increased use of opioids (76% to 82%, aOR = 1.55, P < .001) and benzodiazepines (53% to 66%, aOR = 1.36, P = .02), while gastrointestinal‐related medication use decreased (92% to 89%, aOR = 0.69, P = .001). Patients had decreased exposure to chemotherapy (10% to 5%, aOR = 0.46, P < .001) and anti‐infectives (82% to 73%, aOR = 0.41, P = .002). Vasopressor use increased as death approached (15% to 28%, aOR = 1.67, P = .04). Factors significantly associated with exposure varied with medication category, and included age, race, length of stay, malignancy type, death in the intensive care unit, history of hematopoietic stem cell transplant, and do‐not‐resuscitate status. Conclusion During the week preceding death, administration of symptom management medications increased for children with cancer, but use was not universal. Potentially life‐sustaining medications were often continued. Variability in utilization suggests differences in provider/family decision making that warrant further study to develop an evidence‐based approach to end‐of‐life care.