Pediatric Oncology and Palliative Care

Abstract

Overall, we now cure 70% of the children who are diagnosed with cancer, and in the 30% of cases that are still not curable, we can almost always add time to the child's life. As our ability to cure cancer has improved, we are now paying increased attention to the goal of avoiding or alleviating the suffering associated with cancer and its therapy. Risk stratification aims to avoid undertreatment of children with high-risk cancers and to avoid overtreatment (with all of the associated side effects of therapy) of children with lower-risk cancers. This goal has become an important part of designing treatment protocols over the past 15 years.Whether or not a child will be cured, we know that all children with cancer suffer, as do their families. Pediatric oncology is committed to curing cancer, but palliative care is committed to improving a child's quality of life, irrespective of the potential for cure. Oncology and palliative care are thus twin endeavors, both of which seek what is best for a child and his or her family [1]. Within the 2 broad categories of curing disease and alleviating suffering, there are many specific goals unique to each patient. Palliative care seeks to relieve the physical, emotional, social, and spiritual distress produced by complex, chronic, or life-limiting conditions; to assist in making difficult decisions and setting goals; and to enhance children's quality of life [2].More than a decade has passed since the American Academy of Pediatrics [3] and the Institute of Medicine of the National Academies [4] called for the integration of palliative care into ongoing medical management of lifethreatening illnesses (such as cancer) in children, from diagnosis to the end of life. Since these calls were issued, models of integrated pediatric palliative care have been developed in which curative therapy and palliative care coexist. For children whose lives are going to be short, adding a few months of good-quality life can be transformative. Adding 6 months to the life of a child who would otherwise have died at 3.5 years of age is extending his or her life by nearly 15%.

Cancer Care Research in North Carolina

“…Savings in this area can be facilitated by early use of palliative care services, which can yield improvements in symptoms and functioning, reduction in the number of hospitalizations, reduction in the use of toxic treatments near the end of life, improved quality of life, and decreased costs. These benefits are discussed in a commentary by Bull and Abernethy [28] and in a sidebar by Barfield [29]. Palliative care is not the same as hospice care or end-of-life care.…”

Scientific comment on the theme of palliative care in pediatric hematological oncology patients

“…However, the literature suggests that death at home is considered the first choice, but this happens more frequently only when an integrated palliative care team is available to support family decisions and contain their fear of being abandoned. 2 …”