39 - What Is the Role for Palliative Care in Children With Cancer?

Abstract

Over the past 60 years, the care of children with cancer has shifted dramatically, with more children surviving and with ever-increasing treatment intensity. Children with cancer are at risk for distressing symptoms, social isolation, material hardship, altered life trajectories, spiritual suffering, and death. Families of children who die seek bereavement care. Pediatric palliative care describes a philosophy of “total” care for seriously ill children and their families that addresses the needs of the child’s mind, body, and spirit. Pediatric palliative care recognizes the child’s immediate family members as stakeholders in the child’s care who may themselves require intervention for illness-related distress, particularly in the setting of bereavement. Pediatric palliative care may be practiced by generalists and specialists. Pediatric palliative care is ideally interprofessional, interweaving multiple forms of expertise to ensure comprehensive care. Given the scarcity of specialty pediatric palliative care teams and the evolving capacities of cancer professionals practicing primary pediatric palliative care, the US healthcare system has not yet achieved optimal pediatric palliative care for children with cancer and their families. However, the rapid proliferation of specialty pediatric palliative care teams, the advent of high-quality training and educational programs, and the expansion of pediatric palliative care research all indicate a hopeful future.