title: Does referral to specialist paediatric palliative care services reduce hospital admissions in oncology patients at the end of life?
abstract: BACKGROUND
  Despite advances in the treatment of childhood cancer, some children continue to die from their disease. This study aimed to assess the impact of specialist paediatric palliative care services (SPPCSs) on the number of hospital admissions in children who subsequently died from cancer in Yorkshire, UK.
  
  
  METHODS
  An extract of patients aged 0-19 years from the Yorkshire Specialist Register of Cancer in Children and Young People (YSRCCYP) diagnosed from 1990 to 2009 were linked to inpatient hospital episodes data and a SPPCS database. Deaths were included if they occurred before 31 August 2011. Differences in hospital admission patterns were assessed using negative binomial regression and presented as incidence rate ratios (IRRs).
  
  
  RESULTS
  Of 2508 children on the YSRCCYP, 657 (26%) had died by the censoring date. A total of 211 children had been referred to the local SPPCS, of whom 182 (86%) had subsequently died. Referral to SPPCS was associated with a significant reduction in the rate of planned hospital admissions (IRR=0.60, 95% CI 0.43-0.85). Central nervous system tumours showed significant decreases for all planned and emergency admissions compared with all other diagnostic groups.
  
  
  CONCLUSIONS
  Referral to SPPCS significantly reduced the number of planned hospital admissions for children and young people with cancer before their death, which are often integral to paediatric oncology treatment regimens. Overall, our findings show that SPPCS have a role in reducing hospital admissions during end of life care of paediatric cancer patients with potential personal, social and economic benefits.
authors: Department of Health Sciences, University of York, Room A/TB214, Area 4, Seebohm Rowntree Building, York, YO10 5DD, UK. lorna.fraser@york.ac.uk
authors: L K
authors: LK
authors: Fraser
authors: M
authors: M
authors: van Laar
authors: M
authors: M
authors: Miller
authors: J
authors: J
authors: Aldridge
authors: P A
authors: PA
authors: McKinney
authors: R C
authors: RC
authors: Parslow
authors: R G
authors: RG
authors: Feltbower
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D012017:Referral and Consultation; D013038:Specialization / Q000706:statistics & numerical data*; D013727:Terminal Care; D055815:Young Adult