ArticleBMJ paediatrics open2017
Validation of a classification system for treatment-related mortality in children with cancer.
Article in BMJ paediatrics open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Specialist paediatric palliative care for children and young people with cancer: A mixed-methods systematic review.Palliative medicine · 2020Pooled it
- High-intensity treatment is common at the end of life among children and young people who died of cancer: a retrospective cohort study.BMJ paediatrics open · 2026Article
- Morphologic Leukemia-Free State after Venetoclax-Based Therapy in Acute Myeloid Leukemia is Associated with High Relapse Despite Preserved Short-Term Survival.Mediterranean journal of hematology and infectious diseases · 2026Article
- Treatment-related mortality among children with cancer in Denmark during 2001-2021.Acta oncologica (Stockholm, Sweden) · 2024Article
- What do families want to improve in the management of paediatric febrile neutropenia during anti-cancer treatment? Report of a patient/public involvement group.BMJ paediatrics open · 2019Article
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5 authors.
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Abstract
backgroundDeath not directly due to cancer has been termed 'treatment-related mortality' (TRM). Appreciating the differences between TRM and disease-related death is critical in directing strategies to improve supportive care, interventions delivered or disease progression. Recently, a global collaboration developed and validated a consensus-based classification tool and attribution system.
objectivesTo evaluate the reliability of the newly developed consensus-based definition of TRM and explore the use of the cause-of-death attribution system outside the centre it was initially validated (Toronto, Canada). In the initial study, reviewers listed multiple causes of death. In this study, reviewers identified a primary cause for simplicity.
settingThe paediatric haematology and oncology department at Leeds Teaching Hospital in Leeds, UK.
participantsTwo consultants and two clinical research associates (CRAs).
methodsThirty medical records of the most recent deaths in children with cancer, 2 and 4 weeks prior to death, were anonymised and presented to the participants. Reviewers independently classified deaths as 'treatment related mortality' or 'not treatment related' according to the algorithm developed. When TRM occurred, reviewers applied the cause-of-death attribution system to identify the primary cause of death. Inter-relater reliability was assessed using the kappa statistic (k). MAIN OUTCOME: Inter-relater reliability between CRA and consultants.
resultsReliability of the classification was deemed 'very good' between CRA and consultants (k=0.86, 95% CI 0.72 to 0.97). Ten deaths were classified as TRM, of which infection was the most frequent cause identified. Reviewers disagreed on the primary cause of death (eg, respiratory vs infection) when applying the cause-of-death attribution system in six cases and probable and possible causes in four cases. The study identified how the algorithm may not detect TRM in patients receiving non-curative therapy.
conclusionsThe classification and cause of death attribution system could be implemented in different healthcare settings. Adaptation of the classification tool in patients receiving non-curative interventions and the cause of death attribution system should be considered.
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