Objectives: Early integrated palliative care has shown to improve the quality of life in patients with cancer. During the past decade, pediatric palliative care has become an established area of medical expertise, however due to scant information available regarding the triggers for referral and referral practice very few children receive a formal palliative care consult. Materials and Methods: A retrospective audit of medical case records of pediatric oncology patients over a period of 1 year from September 30, 2019, to September 30, 2020, was conducted. Demographic details, diagnosis, staging, clinical parameters, reason for referral, and palliative care plan were captured in a predesigned pro forma. Results: Among 126 children with cancer, 27 (21.4%) patients were referred to palliative care. Majority 21 (77%) referrals were inpatient consults. Symptom management 17 (44.7%) was the most common trigger for referral followed by referrals for psychosocial support 12 (14.4%). Children with solid tumors 16 (59%) were more often referred than hematological malignancies. Among those needing end of life care, 8 (88.8%) out of 9 families preferred home than hospital. Conclusion: Low incidence of palliative care referral and presence of symptoms as a trigger for palliative care referral suggests gaps in the integrated approach. The study findings prompt a review of palliative care referral criteria and referral practice in a pediatric oncology setting.

The novel coronavirus disease (COVID-19) pandemic has led to significant distress among people of all age groups. Patients with advanced age and severe life-limiting illnesses are at increased risk of death from COVID-19. Not all patients presenting with severe illness will be eligible for aggressive intensive treatment. In limited resource setting, patients may be triaged for supportive care only. This subset of patients should be promptly identified and receive appropriate palliative care with adequate symptom control strategies and psychosocial support. Breathlessness, delirium, pain, and noisy breathing are main symptoms among these patients which can add to the suffering at end-of-life. The COVID-19 pandemic also contributes to the psychological distress due to stigma of the illness, uncertainty of the illness course, fear of death and dying in isolation, and anticipatory grief in families. Empathetic communication and holistic psychosocial support are important in providing good palliative care in COVID-19 patients and their families.

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