Timely Integration of Palliative Care Improves Outcomes in Children with Metastatic Neuroblastoma

Strategic Insights -

Children in developing countries face a high burden of advanced and metastatic cancer, with limited access to palliative care services. A recent study from the Regional Cancer Center in Kerala, India, analyzed the palliative care requirements for children with metastatic neuroblastoma (NB) and evaluated the current palliative care services offered. The study found that early palliative care referral was only necessary for 14.9% of patients, with pain being the most prominent symptom. Shifting care from oncology to palliative care occurred at disease relapse in 66.6% of patients and at end-of-life in 18.3%. The study concluded that timely integration of palliative care and shared care incorporating the oncology team, palliative care team, and local pediatricians can improve treatment outcomes and ensure a continuum of care for children with metastatic cancer.

Key Takeaways:

  • The burden of advanced and metastatic cancer is high among children in developing countries, with limited access to palliative care services.
  • Early palliative care referral occurred in only 14.9% of patients with metastatic NB.
  • Pain was the most prominent symptom among patients with metastatic NB, with nausea/vomiting, constipation, and abdominal distension being common symptoms at end-of-life.
  • Shifting care from oncology to palliative care occurred at disease relapse in 66.6% of patients and at end-of-life in 18.3%.
  • The median time to death for patients with metastatic NB was 9 months from diagnosis and 4 months from relapse.
  • The mean time from initiation of palliative care to death was 4.2 months.
  • Timely integration of palliative care and shared care can improve treatment outcomes and ensure a continuum of care for children with metastatic cancer.

According to the study, palliative care services for children are sparsely available and poorly accessed in developing countries. The study suggests that pediatricians play a crucial role in the shared care model, ensuring a continuum of care and improving the quality of treatment delivered to children with metastatic cancer.

Statistics:

  • 71 patients (85%) died of disease, with a median time to death of 9 months from diagnosis and 4 months from relapse.
  • 58 patients (66.6%) shifted care from oncology to palliative care at disease relapse.
  • 16 patients (18.3%) shifted care to palliative care at end-of-life.
  • 71 patients (85%) died of disease.
  • 67 patients (57%) received palliative care consultation.
  • 59 patients (49.6%) died with pain as the most prominent symptom.

Sources:

  • Optimising Palliative Care for Children with Metastatic Neuroblastoma and the Paediatrician's Role in a Shared Care Model - Proposal from a Regional Cancer Centre in India. Indian Journal of Palliative Care, 2024;30(2):163-167.
  • Regional Cancer Center Reports Findings in Neuroblastomas (Optimising Palliative Care for Children with Metastatic Neuroblastoma and the Paediatrician's Role in a Shared Care Model - Proposal from a Regional Cancer Centre in India). Pediatrics Week. June 29, 2024; p 21.