Integrated home-hospital paediatric palliative care versus standard management in deceased patients with cancer: retrospective cohort study.

Objective: To analyse differences in the last month of life (LMoL) of patients with paediatric cancer, classified depending on if they were included in an integrated home-hospital paediatric palliative care (PPC) programme with 24-hour assistance or received standard oncology care.

Methods: Retrospective cohort study of deceased patients with cancer in HIU Niño Jesús, where the Pediatric Palliative Care Unit of Madrid (PPCUM) is located. Patients were classified based on being attended or not by the PPCUM. General epidemiological and oncological trajectory characteristics and care in LMoL were compared. A logistic regression model for PPCUM referral was established.

Results: 198 patients were included, with 50% of them attended by the PPCUM. In the LMoL, patients attended by the PPCUM used fewer devices, red blood cells and platelet transfusions, surgery, invasive procedures and palliative sedation. They stayed a mean of 16.8 days less at hospital and 8.6 days in the intensive care unit, with 65.7% of them dying at home, while none of the control group did. In the logistic model, relapse/recurrence events as well as having a solid tumour with long diseases trajectories were associated with being attended by the PPCUM. In patients with haematological cancer, longer trajectories were associated with less possibility of receiving PPCUM attention.

Conclusion: The PPC Integrated home-hospital programmes were associated with less invasive interventions and hospital stay. Patients with haematological cancer seem to experience barriers to our intervention.