Retrospective evaluation of palliative care consultation in critically ill adult and pediatric cancer subjects

Importance: Palliative care consultation is an essential component of comprehensive care for patients with cancer during critical illness, as it can improve symptom management and support medical decision-making. However, it is unknown whether the timing and utilization of palliative care differ between pediatric and adult patients in the critical care setting. Objective: We aimed to compare palliative care consultation frequency and timing in critically ill children with cancer with those in adults, hypothesizing that children have more consultations before and during critical care services. Methods: This is a retrospective longitudinal observational cohort study utilizing TriNetX, an electronic health record database, in critically ill cancer subjects aged 0–99 years. The study population was divided into two groups (pediatric [≤18 years] and adults [>18 years]), and the following variables were evaluated: palliative care consultations before and during critical care, critical care interventions, and all-cause 1-year mortality. Odds ratios (ORs) to test for associations between the age category and variables of interest were computed. Results: Our study included 10 049 (251 [2.5%] pediatric and 9798 [97.5%] adult) subjects. Pediatric subjects had higher odds of receiving palliative care consultations prior to critical care (OR = 2.13, 95% confidence interval [CI] = 1.60–2.84, P <0.001), but lower odds of receiving such consultations during critical care services [OR = 0.41, 95% CI = 0.32–0.53, P <0.001]. Interpretation: Patients with cancers can become acutely ill, thus they may benefit from palliative care consultation. Our study found that pediatric patients with cancer had a higher odds of palliative care consultation before critical care, but a lower odds during critical care services. These findings may reflect that referrals for children are often initiated earlier in the disease trajectory, while critical illness itself may not consistently trigger consultation. Overall, the study highlights that palliative care consultations may be underutilized when children with cancer become critically ill.