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Palliative care initiation in pediatric oncology patients: A systematic review

Brian T Cheng1, Michael Rost2, Eva De Clercq2

  • 1Department of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Cancer Medicine
|December 8, 2018
PubMed

Insights

Palliative care (PC) for pediatric cancer patients is often delayed, with discussions and initiation occurring late in the illness. Many children do not receive PC services before death, highlighting a critical gap in care.

Area of Science:

  • Pediatric Oncology
  • Palliative Care Research
  • Health Services Research

Background:

  • Palliative care (PC) is crucial for improving quality of life in pediatric oncology patients and their families.
  • International guidelines recommend PC initiation at diagnosis for children with cancer.
  • Current practice often falls short of recommended early PC integration.

Purpose of the Study:

  • To systematically review studies reporting the timing of palliative care initiation in pediatric oncology.
  • To identify delays in PC discussion and service commencement.
  • To understand the extent to which pediatric cancer patients receive PC services.

Main Methods:

  • Systematic review of literature from PubMed, Web of Science, CINAHL, and PsycInfo.
  • Independent screening and review of 1120 identified citations by two researchers.
  • Inclusion criteria focused on studies reporting empirical time data for PC discussion and initiation in pediatric oncology.

Main Results:

  • Only 16 articles met inclusion criteria, analyzing data from 1120 citations.
  • 54.5% of pediatric oncology patients received any palliative care service before death.
  • PC discussions and initiation were consistently found to occur late in the illness trajectory, near the time of death.

Conclusions:

  • Significant delays exist in both the first discussion of PC and its actual initiation for pediatric cancer patients.
  • Despite recommendations, many children with cancer do not receive timely or any palliative care services.
  • Addressing complex determinants of PC utilization across the illness timeline is essential for earlier integration.

Keywords:
accesscancerpalliativepediatric oncologytiming

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