Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Rong Wang

Second Advisor

Prasanna Ananth


Background: Studies suggest that children, adolescents, and young adults (AYAs) with advanced cancer receive intense end-of-life (EOL) care. This is particularly true for patients with hematologic malignancies. Yet, it is unclear who is at highest risk for receiving intense care.

Methods: We used the Premier Healthcare Database to perform a population-based analysis of patients aged 0-39 years at death with hematologic malignancies who died between 2010-2017. We defined intense EOL care as: receipt of cardiopulmonary resuscitation (CPR), intubation, hemodialysis, or tracheostomy within the last 30 days of life; more than one emergency room (ER) visit within the last 30 days of life; receipt of intravenous chemotherapy within the last 14 days of life; dying in the intensive care unit (ICU); and having a terminal admission of ≥ 30 days. We used multivariate logistic regression to identify predictors of having more intense EOL care (i.e., ≥ 2 intensity indicators).

Results: The study cohort included 2,069 decedent patients. The most prevalent intensity indicators were receiving chemotherapy (51.7%) and being intubated (45.9%). 47.2% of the cohort experienced ≥ 2 intensity indicators. In multivariate analyses, compared with those who had leukemia, AYAs with Hodgkin lymphoma (odds ratio [OR]=1.50, 95% confidence interval [CI]: 1.97, 2.31) and non- Hodgkin lymphoma (OR=1.13, 95% CI: 1.02, 1.49) were more likely to receive intense EOL care. Patients treated in larger hospitals were more likely to receive

intense care (OR: 1.87; 95% CI: 1.18, 2.97). Longer terminal admissions were associated with greater intensity of EOL care.

Conclusion: Children and AYAs in the United States continue to experience intense EOL care. Patients treated at larger hospitals and those who have longer terminal admissions are at particularly high risk. Further research is needed to determine how to mitigate these risks.

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