1470: LIMITATIONS OF LIFE-SUSTAINING INTERVENTIONS IN CRITICALLY ILL CHILDREN WITH CANCER IN LATIN AMERICA

Introduction: Children with cancer frequently experience clinical deterioration events (CDEs), with high mortality and resource utilization, yet limitations of life-sustaining interventions (LLI) remain poorly characterized. Understanding these practices can guide resource allocation and promote goal-concordant care. We hypothesized limited LLI among critically ill children with cancer in Latin America. Methods: Proyecto EVAT is a collaborative to improve early identification of CDEs in children with cancer. Participating hospitals registered CDE characteristics, outcomes, and LLI. Patients with pre-existing LLI were excluded. Treatment-related mortality (TRM) was defined as death from any cause other than cancer progression or relapse. Registry data from April 1, 2017 through December 31, 2024 were included, with each hospitalization used as the unit of analysis. Chi-squared tests evaluated associations between LLI and mortality, TRM, and oncologic diagnoses. Univariate logistic regression estimated the odds of LLI by cancer type. Results: A total of 4490 CDEs occurred during 3993 hospitalizations among 3592 patients at 73 hospitals in 18 countries. LLI were used in 7.6% of hospitalizations, with wide variability across hospitals (range 0 -100%), mainly due to cancer progression (70%). Overall, 32% of hospitalizations resulted in death with 91% during the CDE. Among deaths, 41% occurred within 48 hours of CDE start and 82% were due to TRM. LLI were more common among non-survivors (14% vs 5% survivors, p< 0.0001), in deaths due to cancer progression (37% vs 9% in TRM, p< 0.0001), and in deaths occurring >48 hours after CDE start (21% vs 4% in deaths < 48 hrs since CDE start, p< 0.0001). Compared to patients with hematologic malignancies, those with CNS (OR=3.6, 95% CI [2.5, 5.2], p< 0.0001) and solid tumors (OR=1.8, 95% CI [1.4, 2.4], p< 0.0001) had higher odds of using LLI. Conclusions: LLI use is infrequent among children with cancer experiencing CDEs, even among those who died, suggesting missed opportunities for goal-concordant care. When used, LLI were more often due to cancer progression, suggesting perceived prognosis, rather than severity of acute illness, drives LLI decisions. Despite higher mortality, palliative care principles are underutilized in cancer treatment-related critical illness.