Impact of Race and Ethnicity on End-of-Life Experiences for Children with Cancer (S838)

1.Recognize data regarding racial and ethnic disparities in the provision of end-of-life (EOL) care within the adult oncology literature, and how these data contrast with the limited literature on EOL disparities in the context of pediatric oncology.2.Examine the impact of race and ethnicity on EOL variables for pediatric palliative oncology patients in this study.3.Discuss potential hypotheses to explain why the impact of race/ethnicity on EOL variables may differ between the medical and pediatric oncology literature. Racial and ethnic disparities in the provision of end-of-life (EOL) care are well described in the medical oncology literature. However, the impact of racial and ethnic disparities at EOL in the context of pediatric oncology remains poorly understood. To investigate associations between race/ethnicity and EOL experiences for children with cancer. A retrospective cohort study was conducted on 321 children with cancer enrolled on a palliative care service who died between 2011 and 2015 using a comprehensive standardized data extraction tool comprising a broad spectrum of EOL metrics. Black patients were more likely to receive cardiopulmonary resuscitation as compared to White patients (correlation coefficient=1.413, confidence interval=0.359–2.467, p=0.009); however, the remainder of variables related to treatment and EOL care did not correlate significantly with race. Hispanic patients were less likely to receive cancer-directed therapy within 28 days prior to death (correlation coefficient =-0.708, confidence interval = -1.398–0.018, p=0.044) as compared to White patients, yet they were more likely to report a goal of cure over comfort as compared to Non-Hispanic patients (correlation coefficient =1.129, confidence interval=0.042–2.216, p=0.042). The remainder of EOL variables were not found to be significantly correlated with ethnicity. In contrast with data from the medical oncology literature, neither race nor ethnicity correlated with most EOL variables for pediatric palliative oncology patients treated at a large urban pediatric cancer center. Multicenter investigation is needed to ascertain the impact of racial/ethnic disparities on EOL experiences of children with cancer.