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Background and Objectives For patients receiving end-of-life care, adjusting polypharmacy and deprescription of potentially harmful medicines are important impactors on quality-of-life. Antithrombotic therapies (ATT) are used by 30-50% of patients with cancer, rising to 80% in older cancer patients, and are often continued until a quality-of-life-impacting bleeding event, or a patient is physically unable to take oral medication. We aimed to describe the use of ATT and occurrence of clinical outcomes in patients with cancer during end-of-life care. Approach Linked health and administrative data in SAIL were used to identify end-of-life cancer patients diagnosed in Wales, focusing on cancer types with an estimated 1-year survival time. Survival analysis was used to describe current ATT usage and to investigate the associations between ATT usage and major cardiovascular and bleeding events. Results 21,880 individuals were diagnosed with the pre-defined cancer types between January 2013 and December 2019, 5,660 (26%) of these were taking ATT at diagnosis. During the study period 1670 (30%) were discontinued. Median survival time of patients taking ATT at diagnosis was 169 (IQR 158-180) days, while median time to deprescription was 206 (IQR 190-224) days. Among ATT-users diagnosis, 460 (8%) and 900 (16%) experienced a major bleed or a cardiovascular event, respectively, within 1 year following diagnosis, compared to 1100 (7%) and 1930 (12%) among those who were not prescribed ATT at diagnosis. Conclusions and Implications Our research highlights the need for careful assessment and management of ATT in the interest of improving quality-of-life for patients with cancer during end-of-life care.

Background and Objectives SARS-CoV-2 infection in children and young people (CYP) can lead to life threatening conditions including COVID-19, transmission to more vulnerable individuals, or even long COVID. Vaccination against COVID-19 reduces the chance of infection and transmission of the virus, but vaccine uptake in the UK has been shown to decrease with age. Approach We undertook a multistate-model approach to estimate hazard ratios on national cohorts constructed from linked health and administrative data, adjusting for several demographic factors. The models were applied to 3,433,483 CYP aged 5-17 years between 4th August 2021 and 31st May 2022. The results were combined in a random effects meta-analysis. Results Uptake of the first COVID-19 vaccine in CYP was lower compared to older age groups in the UK, and diminished further with subsequent doses (34%, 20% and 2% for 1st, 2nd, and booster dose respectively). Age of the CYP and vaccination status of the adults in the household were identified as important risk factors. For example, 5-11-year-olds were less likely to receive their first vaccine compared to 16-17-year-olds (adjusted Hazard Ratio [aHR]: 0.10 (95%CI: 0.06-0.19), and CYP in unvaccinated households were less likely to receive their first vaccine compared to partially vaccinated households (aHR: 0.19, 95%CI 0.13-0.29). Conclusions and Implications Our work highlights the need for targeted strategies to increase COVID-19 vaccine acceptance and uptake among CYP, especially considering the influence of parental consent and household factors. Further research could help identify risk factors in household types to investigate more direct associations, which may be influenced by factors such as living with vulnerable people, familial structure, or deprivation.

Abstract SARS-CoV-2 infection in children and young people (CYP) can lead to life-threatening COVID-19, transmission within households and schools, and the development of long COVID. Using linked health and administrative data, we investigated vaccine uptake among 3,433,483 CYP aged 5–17 years across all UK nations between 4th August 2021 and 31st May 2022. We constructed national cohorts and undertook multi-state modelling and meta-analysis to identify associations between demographic variables and vaccine uptake. We found that uptake of the first COVID-19 vaccine among CYP was low across all four nations compared to other age groups and diminished with subsequent doses. Age and vaccination status of adults living in the same household were identified as important risk factors associated with vaccine uptake in CYP. For example, 5–11 year-olds were less likely to receive their first vaccine compared to 16–17 year-olds (adjusted Hazard Ratio [aHR]: 0.10 (95%CI: 0.06–0.19)), and CYP in unvaccinated households were less likely to receive their first vaccine compared to CYP in partially vaccinated households (aHR: 0.19, 95%CI 0.13–0.29).