Predictors of Late Palliative Care Referral in Children With Cancer

Erica C. Kaye, Jonathan Jerkins, Courtney A. Gushue, Samantha DeMarsh, April Sykes, Zhaohua Lu, Jennifer M. Snaman, Lindsay Blazin, Liza Marie Johnson, Deena R. Levine, R. Ray Morrison, Justin N. Baker

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Context: Early integration of palliative care (PC) in the management of children with high-risk cancer is widely endorsed by patients, families, clinicians, and national organizations. However, optimal timing for PC consultation is not standardized, and variables that influence timing of PC integration for children with cancer remain unknown. Objectives: To investigate associations between demographic, disease, treatment, and end-of-life attributes and timing of PC consultation for children with high-risk cancer enrolled on a PC service. Methods: A comprehensive standardized tool was used to abstract data from the medical records of 321 patients treated at a large academic pediatric cancer center, who died between 2011 and 2015. Results: Gender, race, ethnicity, enrollment on a Phase I protocol, number of high-acuity hospitalizations, and receipt of cardiopulmonary resuscitation were not associated with timing of PC involvement. Patients with hematologic malignancy, those who received cancer-directed therapy during the last month of life, and those with advance directives documented one week or less before death had higher odds of late PC referral (malignancy: odds ratio [OR] 3.24, P = 0.001; therapy: OR 4.65, P < 0.001; directive: OR 4.81, P < 0.0001). Patients who received hospice services had lower odds of late PC referral <30 days before death (OR 0.31, P < 0.001). Conclusion: Hematologic malignancy, cancer-directed therapy at the end of life, and delayed documentation of advance directives are associated with late PC involvement in children who died of cancer. Identification of these variables affords opportunities to study targeted interventions to enhance access to earlier PC resources and services for children with high-risk cancer and their families.

Original languageEnglish (US)
Pages (from-to)1550-1556
Number of pages7
JournalJournal of Pain and Symptom Management
Issue number6
StatePublished - Jun 2018


  • Palliative care
  • consultation
  • early integration
  • palliative oncology
  • pediatric oncology
  • timing

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Predictors of Late Palliative Care Referral in Children With Cancer'. Together they form a unique fingerprint.

Cite this