The impact of palliative care consultation on symptom assessment, communication needs, and palliative interventions in pediatric patients with cancer

Abstract

Background: There are few data describing symptom prevalence in children with cancer. The available literature suggests that similar to adults, symptom prevalence and distress are high and that communication regarding end-of-life care needs is limited.

Objectives: We evaluated symptom prevalence, treatment recommendations, and communication about end-of-life care issues for children seen in pediatric palliative care consultation (PCC) at one National Cancer Institute-designated comprehensive cancer center. The goal of our study was to obtain baseline data to target areas in need of intervention.

Methods: A retrospective chart review was conducted of consecutive patients referred to a newly initiated PCC service. Analysis was descriptive.

Results: Over the 9-month study period, 15 children were referred. Median age was 13 years (2-24), with 10 males. Eleven children were receiving chemotherapy and/or radiation. Median number of documented symptoms at PCC was 5 per child (2-10). PCC universally resulted in the detection of symptoms not identified by the primary team, for a median of 3 new symptoms per patient (0-9). Documented communication about most end-of-life care issues with parents was uncommon, and rarely involved children. Initial PPCC resulted in recommendations for medication changes in 14 of 15 children, allied health consultation in 8, counseling in 11, patient care conference in 3, and family conference in 6. For the 12 patients who died, median time from PPCC to death was 8 days (1-96).

Conclusions: PCC, although late in the course, resulted in the detection of multiple symptom control and communication needs, and corresponding treatment recommendations.