The Day Two Talk: Early Integration of Palliative Care Principles in Pediatric Oncology

Abstract

With the publication in 2000 of “Symptoms and Suffering at the End of Life in Children With Cancer” by Wolfe et al,  the dire need for integration of pediatric palliative care into the practice of pediatric oncology was firmly established. Since 2000, the number of hospital- and community-based pediatric palliative care services, fellowship training programs, and educational opportunities for nonspecialists has dramatically increased. With this growth, the importance of the early introduction of pediatric palliative care, regardless of stage and prognosis, has been repeatedly demonstrated and has shown to substantially affect outcomes in multiple areas including patient symptoms and suffering.  As models for early integration of pediatric palliative care have emerged, so too has an understanding of the barriers to implementation, including still inadequate numbers of trained pediatric palliative care specialists, the enduring perception that palliative care is synonymous with end-of-life care, and pediatric oncologists’ lack of clarity about how and when to integrate palliative care and whether or not subspecialty services are available.  Fifteen years later, the barriers remain significant enough that, despite some improvement, Wolfe et al  again demonstrated that children dying as a result of cancer continue to suffer in significant numbers.