Appropriateness of admissions of children with cancer to intensive care facilities in a resource-limited setting

Nadia Beringer,Daynia E Ballot,Jennifer A Geel,Janet E Poole

doi:10.4102/sajo.v1i0.26

Abstract

Background: The increasing intensity of treatment of paediatric malignancies has led to improved survival rates, but often necessitates intensive supportive care. The decision to admit a child to the paediatric intensive care unit (PICU) is based on the probability of both short-term and long-term survival in the context of severe resource constraints. Resource constraints in South Africa result in limited access of children with cancer to PICU facilities. Objectives: The aim of this study was to determine whether referrals by paediatric oncologists to a PICU in Johannesburg were appropriate by analysing indications for admission, underlying diagnoses, duration and costs of admissions, and overall outcomes. Methods: A retrospective review of consecutive PICU admissions over a 12-year period was performed. Data from all patients with histologically proven malignant conditions were included and analysed using descriptive statistical methods, Kaplan–Meier curves, log-rank analysis and Fisher’s exact test. Results: There were 5704 recorded admissions to PICU in the study period. Of these admissions, 120 (2.1%) were for patients with malignancies. The majority of PICU oncology admissions were for post-operative care, and the median duration of stay was 1 day (interquartile range: 1–3 days). The short-term mortality rate of oncology patients in PICU was 13.3% in comparison with 16.2% in the overall PICU population. The 4-year overall survival rate post PICU discharge was 54%. Conclusion: The documented short-term mortality rate indicates that referrals by paediatric oncologists are consistent with current PICU admission policies. Oncologists should assess the prognosis for survival before requesting admission to PICU, and, resources permitting, these patients should be accepted to PICU.

Highlights

The improved survival rates of children diagnosed with cancer in high-income settings are related to advances in treatment modalities as well as access to supportive care.[1]
There were 1071 new oncology patients seen at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) paediatric oncology unit, with a median of 99.5 new patients per year
paediatric intensive care units (PICUs) facilities were required in 103 of 1071 paediatric oncology patients (9.6%), 13 of whom required two admissions, with two patients being admitted to PICU three times

Summary

Introduction

The improved survival rates of children diagnosed with cancer in high-income settings are related to advances in treatment modalities as well as access to supportive care.[1] Patients in upper middleincome countries may have inconsistent access to specialised services, and admission of paediatric oncology patients to paediatric intensive care units (PICUs) is not guaranteed. South Africa has a fragmented, two-tiered health care system based on both privately funded and state-run services. In an attempt to improve equity, a comprehensive National Health Insurance (NHI) plan is envisaged, which will replace the two-tiered model.[2] The imminent introduction of NHI mandates that specialised services in state hospitals be audited in terms of survival and cost. The decision to admit a child to the paediatric intensive care unit (PICU) is based on the probability of both short-term and long-term survival in the context of severe resource constraints. Resource constraints in South Africa result in limited access of children with cancer to PICU facilities

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Discussion

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