Purpose-We assessed the availability and quality of palliative care for children with cancer according to national income per capita.Methods-We surveyed physicians who care for children with cancer using the Cure4Kids website (http://www.cure4kids.org). Queries addressed oncology practice site; reimbursement; specialized palliative care, pain management, and bereavement care; location of death; decisionmaking support; and perceived quality of care. Responses were categorized by low -, middle-, and high-income country (LIC, MIC, HIC).Results-Of 262 completed questionnaires from 58 countries (response rate, 59.8%), 242 were evaluable (55%). Out-of-pocket payment for oncology (14.8%), palliative care (21.9%), and comfort care medications (24.3%) was most likely to be required in LIC (p<0.001). Availability of specialized palliative care services, pain management, bereavement care, and institutional or national decision-making support was inversely related to income level. Availability of highpotency opioids (p=0.018) and adjuvant drugs (p=0.006) was significantly less likely in LIC. Physicians in LIC were significantly less likely than others to report high-quality pain control (p<0.001), non-pain symptom control (p=0.003), and emotional support (p=0.001); bereavement support (p=0.035); interdisciplinary care (p<0.001); and parental participation in decisions (p=0.013). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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