Palliative care initiation in pediatric oncology patients: A systematic review

Abstract

Palliative care (PC) aims to improve quality of life for patients and their families. The World Health Organization and American Academy of Pediatrics recommend that PC starts at diagnosis for children with cancer. This systematic review describes studies that reported PC timing in the pediatric oncology population. The following databases were searched: PubMed, Web of Science, CINAHL, and PsycInfo databases. Studies that reported time of PC initiation were independently screened and reviewed by 2 researchers. Studies describing pilot initiatives, published prior to 1998, not written in English, or providing no empirical time information on PC were excluded. Extracted data included sample characteristics and timing of PC discussion and initiation. Of 1120 identified citations, 16 articles met the inclusion criteria and comprised the study cohort. Overall, 54.5% of pediatric oncology patients received any palliative service prior to death. Data revealed PC discussion does not occur until late in the illness trajectory, and PC does not begin until close to time of death. Despite efforts to spur earlier initiation, many pediatric oncology patients do not receive any palliative care service, and those who do, predominantly receive it near the time of death. Delays occur both at first PC discussion and at PC initiation. Efforts for early PC integration must recognize the complex determinants of PC utilization across the illness timeline.

Home-based Palliative Intervention to Improve Quality of Life in Children with Cancer: A Randomized Controlled Trial

“…But in fact, many clinicians do not have enough understanding about the importance and the roles of early palliative care initiations on children with chronic or life-threatening illnesses. 27,28 Moreover, clinicians working on facilities with hospitalization services only have limited time to dive in the communities. Hospitals are not fit for managing patients' and their families' psychosocial problems.…”

Specialist paediatric palliative care for children and young people with cancer: A mixed-methods systematic review

“…17,[21][22][23][24][25] For children with cancer, referral to palliative care also often occurs late in the trajectory of illness, sometimes only days before death. 26,27 Recent systematic reviews suggest that access to specialist palliative care services is associated with improvements in quality of life, symptom control, perceived support, reduced time in hospital, less invasive treatment and greater advance care planning. 19,28,29 However, these reviews have aggregated the results for children and young people across conditions, and the evidence for those with cancer remains unclear because of conflicting results between individual studies 28 and the lack of work exploring condition-specific factors that may influence access to and benefit from specialist palliative care services.…”

Palliative care utilization in hospitalized children with cancer

“…With calls for greater adoption, it is of clinical importance to estimate the current population‐level provision and resource utilization of PC. A recent systematic review found studies conducted to date have been primarily single‐institution retrospective studies, with limited generalizability due to the small size of single‐institution cohorts and grouping across multiple malignancy types …”