Children dying of cancer are currently receiving care that is more consistent with optimal palliative care and according to parents, are experiencing less suffering. With ongoing growth of the field of hospice and palliative medicine, further advancements are likely.

The assessment and treatment of psychological symptoms such as depression, anxiety, and delirium are complicated in the paediatric palliative care population. Research is limited by the lack of standardized measures, studies that have involved small sample sizes, and the diffi culty in distinguishing between disease and psychological symptoms. Most evidence is extrapolated from the adult palliative care literature, as well as the paediatric psychological and psychiatric literature. Nonetheless, patient-centred care requires that we assess and address these symptoms, which may be difficult to fit into clear diagnostic criteria, but which have a tremendous impact on quality of life. Careful history taking, active listening, and direct observation are an important beginning, and may in and of themselves begin to reduce patient and family distress. Collaboration with mental health professionals to provide specific assessment and non-pharmacological management can also inform the need for psychopharmacological intervention implemented by psychiatrists or palliative care clinicians. Although the data are limited, clinicians can use the available information, as well as their clinical judgement and experience, to inform interventions that can reduce suffering and improve quality of life.