Impact of a multi-professional expert team on EOL care of children with cancer

Abstract

BACKGROUND: The quality of end-of-life (Q-EOL) care is influenced by various factors such as resources for palliative care (PC). We introduced a multi-professional expert team (MET) in 2014, which provides home-based care for children and adolescents with incurable cancer. This study investigated the impacts of the outreach activities by the MET on Q-EOL care of pediatric oncology patients. METHOD(S): This observational study retrospectively examined 112 patients receiving EOL care between 1989 and 2018 at a pediatric cancer center in Japan. Some of the indicators of Q-EOL care before and after the introduction of the outreach activities by the MET were compared. The subjects were 92 in pre-MET and 20 in post-MET periods. RESULT(S): The median days for which the patients stayed at home at the last seven or 30 days were significantly prolonged in post-MET period (0.0 vs. 1.5 days, P=0.020, 3.0 vs. 12.0 days, P=0.042). The change was more significant in hematologic malignancies compared with solid and CNS tumors. Patients receiving longer PC before their deaths could stay at home longer during the last seven days. The ratio of patients receiving PC for more than two months was significantly increased in post-MET period (60.9 vs. 90.0%, P=0.014). In addition, more patients greeted their deaths at home in post-MET period (3.3 vs. 25.0%, P<0.001). CONCLUSION(S): The activities by the MET transformed EOL care of children and adolescents with incurable cancer. Earlier transitions to PC from curative treatment were associated with longer home-based care and more deaths at home. Copyright This article is protected by copyright. All rights reserved.