Care Of Pediatric Cancer Patients Research Articles

Health care providers’ perspectives on the need for palliative care in Upper Egypt: a descriptive exploratory study including children and adult patients

BackgroundOnly four centers in Egypt provide Palliative Care (PC) for adult cancer patients and one provides care for pediatric cancer patients. While PC is not widely utilized in Egypt, this study aims to assess patients’ need for PC from the providers’ perspective. The primary objectives were to assess providers’ knowledge about PC, understand patients’ needs, and compare children’s and adults’ needs for PC.MethodsA descriptive exploratory design was utilized. Patients were recruited from a cancer center in Qena Governorate, Egypt. All 108 nurses and physicians in the cancer center were interviewed to assess their perspectives about PC and patients’ need for it.ResultsOf the 108 care providers, more than 60% of the providers were not familiar with the concept of PC and did not participate in related activities, and more than 77% did not receive any training on the topic. All the providers reported there is no specific policy for end-of-life care. More than 60% of the providers responded that their patients do not need PC as the providers believe that PC provided only for end-stage patients. 50% of the providers see that PC has benefits such as pain relief and symptom management. No major differences were noted between pediatric and adult PC needs.ConclusionThe results of this study provide foundational evidence of providers’ lack of experience with and understanding of palliative care. This deficit is creating a barrier to providing palliative care in Egypt.

Recent Advancements and Innovations in Pediatric Precision Oncology.

Precision oncology incorporates comprehensive genomic profiling into the individualized clinical care of pediatric cancer patients. In recent years, comprehensive pan-cancer analyses have led to the successful implementation of genomics-based pediatric trials and accelerated approval of novel targeted agents. In addition, disease-specific studies have resulted in molecular subclassification of myriad cancer types with subsequent tailoring of treatment intensity based on the patient's prognostic factors. This review discusses the progress of the field and highlights developments that are leading to more personalized cancer care and improved patient outcomes. Increased understanding of the evolution of precision oncology over recent decades emphasizes the tremendous impact of improved genomic applications. New technologies and improved diagnostic modalities offer further promise for future advancements within the field.

Realities and ideals: Experiences and needs of pediatric oncology nurses in communication processes with children and their families at the end‐of‐life period: A photovoice qualitative study

AbstractEffective communication in end‐of‐life care for pediatric cancer patients is crucial. Yet, limited research focuses on the communication experiences of pediatric oncology nurses during this period. This study aims to investigate the communication experiences and needs of these nurses with children and their families during the end‐of‐life period. A qualitative study design with photo voice methodology was followed. The research was conducted with 16 pediatric oncology nurses working in the pediatric oncology wards of a university hospital between January and May 2023. Data were collected the “Characteristic Information Form”, “Semi‐Structured Interview Form”, and photovoice methodology. Data were analyzed through reflexive thematic analysis. Most of the nurses are at the undergraduate level, and their working experience in pediatric oncology wards ranges from 4 months to 17 years. Seven main themes emerged: Optimistic Communication‐Interaction, Mindfulness, Active Coping, Behavioral Actions, Death Uncertainty Dilemma, Interpersonal and Environmental Factors, and Discrepancy between Ideals and Reality. The study sheds light on the importance of pediatric oncology nurses' ideals versus realities upstream approach in communicating with end‐of‐life children and their families, empowering pediatric oncology nurses on the journey to ideal end‐of‐life care.

Ethical Issues and Distressing Aspects Regularly Faced by Healthcare Professionals in the Care of Pediatric Cancer Patients in Indian Context: A Narrative Review from a Bioethics Consortium

Abstract Caring for children affected by cancer presents one of the most challenging situations for both family members and healthcare workers. Treating children is highly complicated compared to adult patients because they do not understand the severity of the ailment, inability to make educated judgments, and tendency to experience pain during procedures and treatment, and require significant emotional support. Furthermore, cancer treatment is often prolonged and expensive, affecting families both psychologically and financially. In such circumstances, healthcare providers bear the responsibility to provide optimal treatment while also addressing the stress and suffering of both the patient and the caregivers. Pediatric oncology healthcare workers are often exposed to a range of medical and non-medical ethical dilemmas, including breaking bad news, obtaining assent and informed consent, managing financial toxicity, addressing oncofertility concerns, managing treatment-induced long-term side effects, and handling end-of-life issues, all of can be highly challenging. Moreover, the resolution of these processes can be complex, often leaving healthcare workers with more questions than answers. There are very few articles addressing the moral issues faced by healthcare workers treating children affected by cancer in India. This review, based on 12 years of work by the Bioethics Consortium, addresses the most commonly encountered clinical aspects in Indian clinics and aims to contribute to the development of teaching and training of healthcare students and professionals.

Improving Home Caregiver Independence With Central Line Care for Pediatric Cancer Patients.

Home caregivers (eg parents) of pediatric patients with cancer with external central lines (CL) must carefully maintain this device to prevent complications. No guidelines exist to support caregiver skill development, assess CL competency, follow-up after initial CL teaching, and support progress over time. We aimed to achieve >90% caregiver independence with CL care within 1 year through a family-centered quality improvement intervention. Drivers to achieve CL care independence were identified using surveys and interviews of patient or caregivers, a multidisciplinary team with patient or family representatives, and piloting clinic return demonstrations (teach-backs). A family-centered CL care skill-learning curriculum, with a postdischarge teach-back program, was implemented using plan-do-study-act cycles. Patients or caregivers participated until independent with CL flushing. Changes included: language iterations to maximize patient or caregiver engagement, developing standardized tools for home use and for teaching and evaluating caregiver proficiency on the basis of number of nurse prompts required during the teach-back, earlier inpatient training, and clinic redesign to incorporate teach-backs into routine visits. The proportion of eligible patients whose caregiver had achieved independence in CL flushing was the outcome measure. Teach-back program participation was a process measure. Statistical process control charts tracked change over time. After 6 months of quality improvement intervention, >90% of eligible patients had a caregiver achieve independence with CL care. This was sustained for 30 months postintervention. Eighty-eight percent of patients (n = 181) had a caregiver participate in the teach-back program. A family-centered hands-on teach-back program can lead to caregiver independence in CL care.

Psychosocial Impact of the War in Ukraine on Pediatric Cancer Patients and Their Families Receiving Oncological Care Outside Their Country at the Onset of Hostilities

Psychosocial care of pediatric cancer patients and their families is as critical as the medical and surgical components of their therapies. Strains on family communication and structure and financial need are linked to poorer psychological outcomes for both patients and families. It is critical that children remain as connected as possible to their communities and extended families during therapy. For Ukrainian pediatric cancer patients receiving care outside of their nation's borders on February 24, 2022, the Russian invasion of Ukraine compounded these problems. Based on conversations with patients and parents, we evaluated the psychosocial impact of war on pediatric Ukrainian cancer patients and their families who had left their country before the onset of the conflict to undergo treatment of pediatric malignancies at our medical center. These families shared with us the problems they have experienced after the Russian invasion of Ukraine. Their concerns can be summarized in 4 categories: (1) emotional stress experienced by the patients, families and relatives related to the dangers of war; (2) difficulties in obtaining previous hospital records in Ukraine; (3) medical expenses; and (4) uncertainty regarding the patient's and their family's future and the ability of the children to ever return to their homes. Psychosocial distress relating to the violence of war will hopefully pass in near future, but our pediatric patients and their families will continue to face stressors related to displacement and financial concerns for some time to come.

Oral Health Condition and Complications in Pediatric Cancer Patients Undergoing Chemotherapy – A Cross-Sectional Study

Background: Better knowledge of the prevalence of oral complications in children with malignancy improves oral health through an interdisciplinary approach between oncologists and pediatric dentists. Aim: This study aimed to assess the prevalence of oral health status in pediatric cancer patients to palliate and relieve the discomfort. Materials and Methods: This study was conducted in a cancer hospital in Hyderabad for 10 days. 158 patients aged [1-15 yrs] diagnosed with malignancy and receiving chemotherapy were selected and evaluated with a self-validated questionnaire followed by oral examination. Results: The data collected was processed and analyzed using the SPSS22 version [Corporation (IBM), Washington, DC., USA]. Mucositis 47% was the most common complication, followed by gingivitis 23.9%, xerostomia 12%, oral pain 11.6%, herpes 3%, and candidiasis 1.8%. Conclusion: Oral care of pediatric cancer patients is of critical importance in maintaining the patient's overall well-being, which can be achieved by a systematic approach at different stages of treatment.

Evaluation of Clinical Findings and Treatment Results of Coronavirus Disease 2019 (COVID-19) in Pediatric Cancer Patients: A Single Center Experience.

ObjectiveThe objective of the study is to evaluate the clinical findings and treatment results of COVID-19 in pediatric cancer patients.Study designThe study was designed as a single-center retrospective observational study. Pediatric cancer patients with COVID-19 admitted to the University of Health Sciences Adana City Training and Research Hospital pediatric COVID wards from October 2020 to October 2021 were included. Clinical data and demographic characteristics were retrieved from patient files.ResultsA total of 45 pediatric cancer patients diagnosed with COVID-19 were included in the study. The mean age of the patients was 8.68 ± 5.16 years (range 1.5–17.5), 62.2% were men, 37.8% were Turkish citizens, and 62.2% were Syrian refugees. A total of 41 patients (91.1%) had leukemia/lymphoma, while 4 (8.9%) had solid tumors. The most common symptoms were fever (66.7%), respiratory (35.6%), and gastrointestinal symptoms (17.8%). Disease severity was evaluated as mild in 46.7%, moderate in 44.4%, and severe in 8.9% of patients. Patients presented with lymphopenia (88.9%), thrombocytopenia (73.3%), anemia (71.1%), and neutropenia (62.2%). Mean hospital length of stay was 15.18 ± 10.34 (range 6–62) days overall and 9.5 ± 2.39 (range 2 to 28) days in the PICU. Intensive care unit admission rate was 8.9%, and mortality rate was 4.4%. Median viral shedding period was 21 days (range 7–52).ConclusionsOur study reveals that the mortality rate, length of hospital stay, and the need for intensive care of pediatric cancer patients with COVID-19 are higher than those of healthy children. Prospective studies with larger sample sizes are needed to further evaluate the clinical findings and treatment results of COVID-19 in pediatric cancer patients.

Emergency management of fever and neutropenia in children with cancer: A review.

Care of pediatric cancer patients is increasingly being provided by physicians in community settings, including general emergency departments. Guidelines based on current evidence have standardized the care of children undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT) presenting with fever and neutropenia (FN). This narrative review evaluates the management of pediatric patients with cancer and neutropenic fever and provides comparison with the care of the adult with neutropenic fever in the emergency department. When children with cancer and FN first present for care, stratification of risk is based on a thorough history and physical examination, baseline laboratory and radiologic studies and the clinical condition of the patient, much like that for the adult patient. Prompt evaluation and initiation of intravenous broad-spectrum antibiotics after cultures are drawn but before other studies are resulted is critically important and may represent a practice difference for some emergency physicians when compared with standardized adult care. Unlike adults, all high-risk and most low-risk children with FN undergoing chemotherapy require admission for parenteral antibiotics and monitoring. Oral antibiotic therapy with close, structured outpatient monitoring may be considered only for certain low-risk patients at pediatric centers equipped to pursue this treatment strategy. Although there are many similarities between the emergency approach to FN in children and adults with cancer, there are differences that every emergency physician should know. This review provides strategies to optimize the care of FN in children with cancer in all emergency practice settings.

Therapeutic interventions for childhood cancer: An umbrella review of randomized evidence.

Treatment advancements in pediatric cancer have improved prognosis, but the strength of supporting evidence has not been thoroughly evaluated. To critically appraise it, we performed an umbrella review of meta-analyses of randomized controlled trials examining the efficacy and safety of therapeutic interventions for pediatric malignancies. Fourteen publications (68 meta-analyses, 31,496 participants) were eligible. Acute lymphoblastic leukemia (ALL) was investigated at most. Substantial heterogeneity was detected in 10 associations, with limited indications for small-study effects and excess-significance bias. The most concrete evidence pertained to the use of methotrexate and vincristine-prednisone pulses for ALL, improving event-free survival. Evidence regarding other cancers was relatively weak. Conclusively, we found few small meta-analyses focusing mainly on ALL. Randomized evidence stemming from adult populations still seems to serve as valuable indirect evidence backup. More randomized evidence and individual patient data meta-analyses are needed to increase certainty and precision in the care of pediatric cancer patients.

Abstract 98: Custom Gene Fusion Assays for the Rapid Diagnosis of Pediatric Cancers in Low-Resourced Settings

Abstract Purpose: Risk stratification and molecular targeting have been key to increasing cure rates for pediatric cancers in high-income countries. Precise diagnosis and successful treatment of pediatric cancer in low-resourced settings is often hindered by insufficient pathology infrastructure, including lack of laboratory platforms for molecular analysis. Given the high frequency of gene fusions in pediatric cancers, identifying such fusions would greatly aid cost-effective pediatric cancer diagnosis, risk stratification, and precision medicine in low-resourced settings. Methods: To allow for implementation of gene fusion detection at Global HOPE sites in Sub-Saharan Africa (SSA), methodologies were reviewed to consider minimal technical expertise required, the ability to utilize samples with sub-optimal RNA quality, and rapid turn-around-time. Literature review, clinical laboratory results, public databases, and large-scale genomic studies were used to obtain exact breakpoint sequence information for gene fusions associated with pediatric and adolescent cancers. Results: Two custom pediatric gene fusions panels were designed using the NanoString Elements technology. The hematologic malignancy panel was designed to detect 439 breakpoints for 223 non-IGH/TCR fusions reported in ALL, AML, lymphomas, and histiocytosis. The solid tumor panel was designed to detect 204 breakpoints for 436 fusions associated with pediatric sarcomas, brain tumors, and renal malignancies. Each panel was tested using 96 samples with known fusion status at Texas Children's Hospital to determine specificity, sensitivity, precision, and ease of workflow. Conclusions: The design, testing, and implementation of a rapid assay to detect gene fusions with diagnostic, prognostic, and therapeutic impact would be transformational in the care of pediatric cancer patients in low-resourced settings. The custom designed panels will allow for large-scale fusion detection in 2-3 days with only 15 minutes of technician time after RNA isolation. Additional steps are needed to identify and address any challenges upon initiation in SSA to fully realize the potential of such technology. Citation Format: Julie Gastier-Foster, Fredrick Lutwama, Joseph Lubega, Kevin Fisher, Dolores Lopez-Terrada, Angshumoy Roy, Nmazuo Ozuah, Jeremy Slone, Peter Wasswa, Carl Allen, David Poplack. Custom Gene Fusion Assays for the Rapid Diagnosis of Pediatric Cancers in Low-Resourced Settings [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 98.

ВВЕДЕНИЕ В ПРОБЛЕМУ ОРГАНИЗАЦИИ МЕДИКО-ПСИХОЛОГИЧЕСКОГО СОПРОВОЖДЕНИЯ ОНКОПАЦИЕНТОВ ДЕТСКОГО ВОЗРАСТА И ИХ РОДИТЕЛЕЙ

Statement of the problem. The article provides an overview of theoretical and experimental studies related to the organization of medical and psychological support for pediatric cancer patients and their immediate environment – parents. There is a contradiction between the increased attention to the issue of providing medical and psychological assistance to cancer patients and the lack of a comprehensive model of care focused on relying on the patient’s personality, taking into account the uniqueness of assistance at different stages of treatment and, depending on the child’s age, providing psychological support to the immediate environment of the childhood cancer patient. The purpose of the article is to analyze the current state of the problem on providing systematic medical and psychological assistance to pediatric cancer patients and their families, to identify various organizations of psychological support for this category of addressees of psychological assistance. The research methodology is based on the ideas of the system approach, psychosomatic approach, cultural and historical development of the human psyche, statements of the subject-activity approach. Research results. The analysis of the targets of medical and psychological care for pediatric cancer patients and their parents, presented in modern Russian and foreign sources, is presented. Problems in the implementation of medical and psychological assistance to children with cancer and their families are generalized. Conclusion. As a result of the analysis of the problems, the prospects for the study of medical and psychological care for pediatric cancer patients and their parents are outlined: the study of the personality characteristics of cancer patients and their parents, the study of the features of the formation of adaptive types of attitudes towards the disease in families, the development and testing of a model of medical and psychological care for this category of persons.

Ethical Challenges in Pediatric Oncology Care and Clinical Trials.

The care of pediatric cancer patients is a vast departure from cancer care of adults. While the available treatment modalities-chemotherapy, radiation, and surgery-are the same, the diseases, care-delivery, and outcomes differ greatly. And just as 'children are not just little adults,' pediatric bioethics occupies a distinct place within the broader field of bioethics. In this chapter, we will begin with an introduction to fundamental principles and frameworks for understanding ethical issues in pediatrics, highlighting the triadic nature of medical decision-making between a physician, the child-patient, and the child's parent as the surrogate decision-maker. We will then delve into further details of how these principles and frameworks shape the care of children with cancer, examining specific ethical challenges commonly encountered by pediatric oncologists. We will traverse this landscape by examining issues involving (a) informed consent; (b) research involving children; (c) end of life; (d) genetic and genomic testing; and (e) professionalism. We also examine ethical challenges in clinical research, in children and more broadly. While not an exhaustive exploration of the myriad ethical issues one might encounter in pediatric cancer medicine and clinical trials, this chapter provides readers with a foundation for further reading.

Trans-Sectoral Patient Care in Pediatric Oncology: Quality Assurance by Novel Reimbursement Models for Outpatient Services

The medical care of pediatric cancer patients in the German health care system relies on special structures. All children and adolescents with a diagnosis of cancer receive uniform treatment within clinical studies or registers and exclusively at centers which can ensure interdisciplinary care by a multiprofessional team. Reimbursement of outpatient services is highly heterogeneous among the centers, and the expenses are often not adequately compensated. A nation-wide survey was performed among all centers of the German Society of Pediatric Hematology and Oncology, with a standardized questionnaire inquiring which reimbursement models are used to finance outpatient treatment and whether full coverage of the expenses is achieved. Of 58 Pediatric Oncology Centers in Germany 18 (33%) participated in the survey, including 8 (44%) University Hospitals. The use of available reimbursement tools was highly heterogeneous. Reimbursement for outpatient service was based on a mean of 3,33±1,49 individual components. Of the 18 responding centers, 17 indicated that the revenues do not fully cover the expenses. Pediatric oncology centers in Germany can not achieve full coverage of expenses in the outpatient setting. Nationally uniform cost-covering remuneration strategies are needed. This article proposes three individual models for an adequate nationwide financial framework for the outpatient care of pediatric cancer patients.

Chaplain care in pediatric oncology: Insight for interprofessional collaboration

Although attending to spiritual and religious needs is part of high quality care of pediatric cancer patients, oncology clinicians may not understand the role of the chaplain, resulting in underutilization of resources and failure to fully integrate the chaplain into the clinical team. We provide a description of what the chaplain does in the care of pediatric oncology patients. We conducted a qualitative content analysis of chaplain chart notes over a one-year period on the pediatric oncology service at a freestanding children's hospital. Using criteria designed to capture multiple potential factors in chaplain referral, we selected 30 patients for thematic analysis. In 2016, 166 pediatric patients were diagnosed with cancer and received ongoing care at our institution. From the 30 patients selected, 230 chaplain encounters were documented in the medical chart. Three major themes emerged. (1) The chaplains provided a rich description of spiritual and psychosocial aspects of the patient and family's experience; (2) chaplains provided diverse interventions, both religious and secular in nature; and (3) chaplains provided care within a longitudinal relationship. All three themes depend on the empathic listening by a chaplain. The chaplains' observations about patient and family beliefs, experiences, and emotional/spiritual states have the potential to inform the interdisciplinary care of the patient. Chaplain documentation provides insight into how spiritual care interventions and close relationships may promote patient and family well-being. In future work, we will explore how to give voice to their insights in caring for pediatric oncology patients.

Development of a Proxy Quality-of-Life Rating Scale for the End-of-Life Care of Pediatric Cancer Patients Evaluated from a Nurse's Perspective.

Background: Assessing the quality of life (QoL) of children receiving end-of-life (EoL) care through evaluations by the children and their bereaved families is challenging; presently, there is no QoL assessment measure that is appropriate for use in pediatric EoL and/or palliative care. Objective: To develop and test a proxy rating scale (the "Good Death Inventory for Pediatrics," GDI-P) for the QoL of pediatric cancer patients receiving EoL care, evaluated from the nurse's perspective, as well as a short version of the scale. Design, Setting, and Measurements: The GDI-P was developed based on previous studies. After initial testing, it was distributed to hospitals across Japan, where nurses in charge of patients with childhood cancer receiving EoL care used the scale to evaluate a patient retrospectively. To examine inter-rater reliability, we encouraged two nurses to evaluate one patient. The GDI-P was modified on the basis of the responses, and the validity and reliability were measured. Results: In total, 85 questionnaires were completed, including 32 pairs of responses from two nurses evaluating one patient. In addition, 47 retest questionnaires were returned. The final, modified GDI-P comprised eight factors with 22 items and showed high convergent and discriminant validity, scaling success rates for each item and factor, and Cronbach's α values. A short version of GDI-P was prepared, comprising eight representative items. Conclusions: The final GDI-P was confirmed to have adequate reliability and validity. The QoL scale developed in this study should provide useful outcome evaluation criteria for assessing the EoL care of pediatric cancer patients.

Pediatric Interventional Oncology: Endovascular, Percutaneous, and Palliative Procedures

Abstract Interventional oncology (IO) is emerging as a pillar of cancer care in pediatric patients. The minimally invasive techniques employed by IO are increasingly being integrated into the diagnostic, therapeutic, and palliative management of children with cancer. This review provides an evidence-based overview to the endovascular, percutaneous, and supportive and palliative procedures offered by pediatric interventional radiologists. An understanding of the modest but growing literature that supports the safety and efficacy of pediatric IO is important in ensuring the continued adoption of IO in the multidisciplinary care of pediatric cancer patients.

Genetic Predisposition to Childhood Cancer in the Genomic Era.

Developments over the past five years have significantly advanced our ability to use genome-scale analyses-including high-density genotyping, transcriptome sequencing, exome sequencing, and genome sequencing-to identify the genetic basis of childhood cancer. This article reviews several key results from an expanding number of genomic studies of pediatric cancer: (a) Histopathologic subtypes of cancers can be associated with a high incidence of germline predisposition, (b) neurodevelopmental disorders or highly penetrant cancer predisposition syndromes can result from specific patterns of variation in genes encoding the SMARC family of chromatin remodelers, (c) genome-wide association studies with relatively small pediatric cancer cohorts have successfully identified single-nucleotide polymorphisms with large effect sizes and provided insight into population differences in cancer risk, and (d) multiple exome or genome analyses of unselected childhood cancer cohorts have yielded a 7-10% incidence of pathogenic variants in cancer predisposition genes. This work supports the increasing use of genomic sequencing in the care of pediatric cancer patients and at-risk family members.

The effectiveness of solution-focused brief therapy for psychological distress among Chinese parents of children with a cancer diagnosis: a pilot randomized controlled trial.

Given the critical role of parental care for pediatric cancer patients, this pilot study evaluated the feasibility and effectiveness of a hospital-based solution-focused brief therapy (SFBT) intervention for reducing psychological distress among parents of pediatric cancer patients in China. Differences between treatment and active control (AC) groups were assessed on dimensions of psychological distress. Parents' level of hope was also assessed. Participants (N = 44) were randomly assigned to SFBT or AC. Parents received four sessions of SFBT twice a week delivered by graduate-level hospital social workers. Pre- and post-intervention assessments measured change in distress (depression, anxiety, and somatization symptoms) of parents as well as their level of hope. Analysis of covariance (ANCOVA) indicated the SFBT group had better outcomes than the AC group on overall distress of somatic, anxiety, depression symptoms and level of hope. Within- and between-group treatment effects reported significantly greater effect of the SFBT group than of the AC group. Considering the inherent limits of a pilot feasibility study, results suggest that SFBT is a feasible, culturally compatible, and promising intervention for alleviating distress among Chinese parents of children with cancer. Additional comprehensive trials are needed to draw more definitive conclusions. SFBT may be beneficial for improving the critical support systems of parents of pediatric cancer patients. Thus, SFBT may have the potential to enhance children's well-being during cancer treatment and recovery.

Areas for quality improvement in pediatric supportive oncology services.

146 Background: In 2013, the Institute of Medicine report recommended that supportive oncology services be initiated at time of diagnosis. Providers of pediatric cancer care in the Chicagoland community, supported by The Coleman Foundation, sought to define areas for quality improvement of supportive oncology delivery to children. Methods: Focus groups and surveys with clinicians providing pediatric cancer care and supportive services at 14 sites were used to prioritize areas needing improvement. Results: 100% (14/14) of sites participated. Of the eligible sites, 6 were pediatric cancer treatment sites and 8 cancer care community organizations. Sites demonstrated consistent agreement for 8 of the 12 areas of focus for improvement. Over 50% of sites reported areas of focus (table) as important or very important. Conclusions: Sites identified the need for quality improvement in delivery of psychosocial, survivorship and palliative care for pediatric cancer patients. Survey results demonstrate a need for collaboration and efforts to guide care delivery improvement across sites. [Table: see text]