New model of integrated pediatric palliative oncology care: the CSC

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Although typically occurring late in the disease course, pediatric palliative care (PPC) improves quality of life and end-of-life outcomes for children with cancer. The Supportive Care Clinic (SCC) opened in 2017 to provide access to outpatient CPPs. Describe the first 4 years (2017-2021) of an academic advisory CHC focused on pediatric oncology.

Calculations were performed for descriptive data (demographics, disease, treatment, visit and end of life) and changes over time.

A total of 1,143 clinic visits (median 4, IQR 2.6), comprising 248 consultations and 895 follow-up visits, were made by 248 patients during the first 4 years at CSC (of which 51.6% were men, 58.1% Caucasian, 35.5% Black, and 13.7% Hispanic/Latino). From the 1st to the 4th year, the number of visits to the clinic almost tripled. Leukemia/lymphoma (17.3%), solid tumors (37.5%) and central nervous system tumors (41.9%) were the most frequent primary diagnoses. For most of the patients referred, the SCC (70.6%) was the initial contact site for the CPP. Of the 136 patients who died (54.8%), 77.9% had received medical orders for life-sustaining treatment or a do-not-resuscitate order, and 72.8% received palliative care. About 89.3% of these died at their preferred location (n=112) when known. In four years, the interval between CHC consultation and death has increased from 74 to 226 days (P

Integrated SCC clinics can be productive, grow cohesively, provide better end-of-life treatment for children with cancer, and improve PPC referrals and planning. In addition, CSC outpatient services should be available at major pediatric cancer centers.

Reference: jpsmjournal.com/article/S0885-3924(22)00738-2/fulltext

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