P3B059: Trach Dependent: A Single Center Retrospective Review of Tracheostomies in Children with Cancer

Background: Advances in pediatric and intensive care have led to an increase in the number of children with complex medical needs with a tracheostomy and/or long-term ventilatory support. In pediatrics, they are considered a major decision point in the care of children with medical complexity. Decision-making regarding tracheostomy can be complicated and have ethical implications, especially in patients with poor prognosis or at the end of life.

Cancer is one of the least common conditions among pediatric tracheostomy patients, accounting for only 3.5% of cases in some studies. There is a lack of literature describing the population of pediatric cancer patients who undergo this procedure apart from a few case reports and series.

The goal of this single-center retrospective review is to provide insight into the population of cancer patients with tracheostomies at a large pediatric cancer referral center. We aim to describe the epidemiology of tracheostomy in pediatric cancer patients and shed light on the kinds of prognostic, palliative, and decision-making conversations that may be happening surrounding the procedure in this population.

Methods: We reviewed the charts of patients ≤26 years of age who had tracheostomies placed from January 2000 to March 2022 and were treated by the Department of Pediatrics at Memorial Sloan Kettering Cancer Center. Patients with tracheostomies were identified using International Classification of Diseases codes. Descriptive and comparative statistics characterized the patient demographics, reasons for tracheostomy, clinical scenarios, and outcomes. Case narratives were constructed and analyzed thematically.

Results: There were 74 children who received tracheostomies during the study period, with a total of 78 placed. Of these, 16 were part of a surgical resection with reconstruction for head/neck cancer and were removed by operative admission discharge. The remaining 62 occurred in 61 children. Cancer diagnoses were diverse, with brain tumors the most common (27, 44%). Nearly a quarter (14, 23%) were placed within 30 days of cancer diagnosis, and two predated the cancer diagnosis. Reasons for tracheostomy included: central apnea, vocal cord paralysis, inability to maintain airway, respiratory failure, infection, and airway obstruction and others. Forty-four (72%) died, and 15 (25%) had tracheostomy placement during their terminal admission. At least 7 (11%) were described as at “end of life” prior to the procedure. Two of the deaths were by neurological criteria. Thematic analysis is ongoing.

Conclusion: This is the first description of pediatric cancer patients with tracheostomies. While many were placed in patients undergoing treatment with curative intent or prognostic uncertainty, a significant number of patients had advanced disease. Children with cancer undergoing the procedure are medically complex and at high risk of death, both overall and during the tracheostomy admission, making this an important population to understand further.