Kaye Erica C, Gushue Courtney A, DeMarsh Samantha, Jerkins Jonathan, Li Chen, Lu Zhaohua, Snaman Jennifer M, Blazin Lindsay, Johnson Liza-Marie, Levine Deena R, Morrison R Ray, Baker Justin N
1 Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
2 Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
Am J Hosp Palliat Care. 2019 Sep;36(9):767-774. doi: 10.1177/1049909119836939. Epub 2019 Mar 13.
Racial and ethnic disparities in the provision of end-of-life care are well described in the adult oncology literature. However, the impact of racial and ethnic disparities at end of life in the context of pediatric oncology remains poorly understood.
To investigate associations between end-of-life experiences and race/ethnicity for pediatric patients with cancer.
A retrospective cohort study was conducted on 321 children with cancer enrolled on a palliative care service at an urban pediatric cancer who died between 2011 and 2015.
Compared to white patients, black patients were more likely to receive cardiopulmonary resuscitation (CPR; odds ratio [OR]: 4.109, confidence interval [CI]: 1.432-11.790, = .009) and underwent 3.136 (CI: 1.433-6.869, = .004) CPR events for every 1 white patient CPR event. The remainder of variables related to treatment and end-of-life care were not significantly correlated with race. Hispanic patients were less likely to receive cancer-directed therapy within 28 days prior to death (OR: 0.493, CI: 0.247-0.982, = .044) as compared to non-Hispanic patients, yet they were more likely to report a goal of cure over comfort as compared to non-Hispanic patients (OR: 3.094, CI: 1.043-9.174, = .042). The remainder of variables were not found to be significantly correlated with ethnicity.
Race and ethnicity influenced select end-of-life variables for pediatric palliative oncology patients treated at a large urban pediatric cancer center. Further multicenter investigation is needed to ascertain the impact of racial/ethnic disparities on end-of-life experiences of children with cancer.
成人肿瘤学文献中对临终关怀提供方面的种族和民族差异已有充分描述。然而，儿科肿瘤学背景下临终时种族和民族差异的影响仍知之甚少。
调查癌症患儿临终体验与种族/民族之间的关联。
对2011年至2015年间在一家城市儿科癌症姑息治疗服务机构登记的321名癌症患儿进行回顾性队列研究。
与白人患者相比，黑人患者更有可能接受心肺复苏（CPR；优势比[OR]：4.109，置信区间[CI]：1.432 - 11.790，P = 0.009），且每1例白人患者接受CPR时，黑人患者接受3.136次（CI：1.433 - 6.869，P = 0.004）CPR事件。与治疗和临终关怀相关的其余变量与种族无显著相关性。与非西班牙裔患者相比，西班牙裔患者在死亡前28天内接受癌症定向治疗的可能性较小（OR：0.493，CI：0.247 - 0.982，P = 0.044），但与非西班牙裔患者相比，他们更有可能报告治愈目标而非舒适目标（OR：3.094，CI：1.043 - 9.174，P = 0.042）。其余变量与民族无显著相关性。
种族和民族影响了在一家大型城市儿科癌症中心接受治疗的儿科姑息肿瘤患者的某些临终变量。需要进一步开展多中心调查，以确定种族/民族差异对癌症患儿临终体验的影响。
