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Published on: September 30, 2016
The Supportive Care Clinic: A Novel Model of Embedded Pediatric Palliative Oncology Care
Katharine E Brock1, Nicholas P DeGroote2, Anna Roche2
1Aflac Cancer & Blood Disorders Center of Children's Healthcare of Atlanta (K.E.B., N.P.D., A.R., K.W.), Atlanta, Georgia, USA; Department of Pediatrics, Division of Pediatric Hematology/Oncology (K.E.B., K.W.), Emory University. Atlanta, Georgia, USA; Department of Pediatrics, Division of Pediatric Palliative Care (K.E.B.), Emory University, Atlanta, Georgia, USA.
Insights
Supportive Care Clinics (SCC) provide timely pediatric palliative care (PPC) for children with cancer, improving end-of-life outcomes and increasing consultation timing. These clinics enhance care for pediatric oncology patients.
Area of Science:
- Pediatric Oncology
- Palliative Care
- Cancer Survivorship
Background:
- Pediatric palliative care (PPC) is crucial for improving quality of life and end-of-life outcomes in children with cancer.
- PPC is often initiated late in the disease trajectory, limiting its potential benefits.
- The Supportive Care Clinic (SCC) was established to enhance outpatient PPC accessibility.
Purpose of the Study:
- To evaluate the initial four years (2017-2021) of an academic, consultative, and embedded SCC within a pediatric oncology setting.
- To describe patient demographics, disease characteristics, and care patterns within the SCC.
- To assess the impact of the SCC on the timing and delivery of PPC.
Main Methods:
- Descriptive statistics were used to analyze demographic, disease, treatment, visit, and end-of-life data.
- Trends over the four-year period were calculated.
- Data included patient characteristics, number of visits, diagnoses, and end-of-life care preferences.
Main Results:
- The SCC served 248 patients, with a significant increase in clinic visits (nearly 300%) from year one to year four.
- Most referred patients (70.6%) had their first PPC contact through the SCC.
- Among deceased patients, a high percentage received advance care planning (77.9%) and hospice care (72.8%), with most dying in their preferred location (89.3%).
- The time from SCC consultation to death significantly increased from 74 to 226 days, with a greater proportion of consultations occurring >90 days before death (39.1% to 85.0%).
Conclusions:
- Embedded SCCs are effective in pediatric oncology settings, demonstrating growth and improved PPC referrals and timing.
- SCCs enhance end-of-life care for children with cancer.
- Pediatric cancer centers should integrate SCC outpatient services to optimize care delivery.
Context:
Pediatric palliative care (PPC) improves quality of life and end-of-life outcomes for children with cancer, but often occurs late in the disease course. The Supportive Care Clinic (SCC) was launched in 2017 to expand outpatient PPC access.
Objectives:
To describe the inaugural four years (2017-2021) of an academic, consultative, embedded SCC within pediatric oncology.
Methods:
Descriptive statistics (demographic, disease, treatment, visit, and end-of-life) and change over time were calculated.
Results:
During the first four years, 248 patients (51.6% male; 58.1% White; 35.5% Black; 13.7% Hispanic/Latino) were seen in SCC, totaling 1,143 clinic visits (median 4, IQR 2,6), including 248 consultations and 895 follow-up visits. Clinic visits grew nearly 300% from year one to four. Primary diagnoses were central nervous system tumor (41.9%), solid tumor (37.5%), and leukemia/lymphoma (17.3%). The first point of PPC contact became SCC (70.6%) for most referred patients. Among the 136 deceased patients (54.8%), 77.9% had a do-not-resuscitate or Physician Orders for Life Sustaining Treatment in place, and 72.8% received hospice care. When known (n = 112), 89.3% died in their preferred location. The time from SCC consultation to death increased from 74 to 226 days over the four years (P < 0.0001). The proportion of SCC consultations that occurred greater than 90 days from death increased from 39.1% in year one to 85.0% in year four.
Conclusion:
Embedded SCC clinics can be successful, achieve steady growth, improve referrals and timing of PPC, and enhance end-of-life care for children with cancer. Large pediatric cancer centers should include SCC outpatient services.
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