{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T06:15:34Z","timestamp":1770358534349,"version":"3.49.0"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T00:00:00Z","timestamp":1607644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe medication utilization patterns by pediatric inpatients with cancer during their last week of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study used data from the Vizient Clinical Database\/Resource Manager, a national compilation of clinical and resource use data from over 100 academic medical centers and affiliates. Patients (0\u201021\u00a0years) with malignancy who died during hospitalization (2010\u20102017) were included (N\u00a0=\u00a01659). Medications were categorized as opioid, benzodiazepine, gastrointestinal related, chemotherapy, anti\u2010infectives, or vasopressors. Exposure to each group was ascertained for all patients at 1\u00a0week and 1\u00a0day prior to death. Factors associated with exposure were examined using generalized estimating equations, and summarized using adjusted odds ratios (aORs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over the last week of life, there was increased use of opioids (76% to 82%, aOR\u00a0=\u00a01.55, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and benzodiazepines (53% to 66%, aOR\u00a0=\u00a01.36, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.02), while gastrointestinal\u2010related medication use decreased (92% to 89%, aOR\u00a0=\u00a00.69, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.001). Patients had decreased exposure to chemotherapy (10% to 5%, aOR\u00a0=\u00a00.46, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and anti\u2010infectives (82% to 73%, aOR\u00a0=\u00a00.41, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.002). Vasopressor use increased as death approached (15% to 28%, aOR\u00a0=\u00a01.67, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.04). Factors significantly associated with exposure varied with medication category, and included age, race, length of stay, malignancy type, death in the intensive care unit, history of hematopoietic stem cell transplant, and do\u2010not\u2010resuscitate status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>During the week preceding death, administration of symptom management medications increased for children with cancer, but use was not universal. Potentially life\u2010sustaining medications were often continued. Variability in utilization suggests differences in provider\/family decision making that warrant further study to develop an evidence\u2010based approach to end\u2010of\u2010life care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.28837","type":"journal-article","created":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T14:40:02Z","timestamp":1607697602000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Patterns of medication use at end of life by pediatric inpatients with cancer"],"prefix":"10.1002","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5022-8885","authenticated-orcid":false,"given":"Stephanie","family":"Prozora","sequence":"first","affiliation":[{"name":"Department of Pediatrics Yale School of Medicine  New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronika","family":"Shabanova","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Yale School of Medicine  New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5614-7445","authenticated-orcid":false,"given":"Prasanna","family":"Ananth","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Yale School of Medicine  New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2883-0957","authenticated-orcid":false,"given":"Farzana","family":"Pashankar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Yale School of Medicine  New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary M.","family":"Kupfer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Georgetown University School of Medicine  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie A.","family":"Massaro","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Yale School of Medicine  New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy J.","family":"Davidoff","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Yale School of Public Health  New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1043454204264407"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21442"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21219"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25479"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30860"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-0671"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-016-2837-0"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/jayao.2018.0123"},{"key":"e_1_2_8_10_1","unstructured":"World Health Organization.WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents.WHO;2018.https:\/\/www.who.int\/ncds\/management\/palliative-care\/cancer-pain-guidelines\/en\/. 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