Palliative care service in patients with childhood cancer from a tertiary pediatric oncology center

Abstract

Importance: Pediatric palliative care (PPC) has gained great attention in western countries, however data on Hong Kong children receiving PPC are limited. There are gaps in knowledge about the PPC needs in local children with cancer. Objective: To assess the current situation of PPC service of Hong Kong children with cancer. Methods: We performed a 10-year retrospective review in a tertiary pediatric oncology unit and studied the referral pattern, clinical characteristics and services provided. Results: Totally 117 children were referred to PPC Team which constituted 65% deceased children within the study period. The commonest diagnoses were central nervous system tumour (32.5%), leukaemia (25.6%) and neuroblastoma (9.4%). Ninety-one percent of children were referred after the last relapse or stopping curative treatment. The median time of referral to death was 77 days [interquartile range (IQR): 35, 182]. The median number of hospital admission after referral was 2 (IQR: 1, 5), with a median of 27 days total hospital stay (IQR: 10, 60). The reasons for admission were palliative chemotherapy (16.1%), pain control (12.1%) and platelet transfusion (11.2%). For the death episode, the median duration of hospital stay was 15 days (IQR: 2, 46). Most patients received oxygen (82.0%), intravenous fluid (81.2%) and intravenous analgesic (52.1%). A total of 111 (94.9%) children died in hospital, 15 had been admitted into intensive care unit (ICU) but only 5 (4.5%) died in ICU. Interpretation: Pain control and platelet transfusion were common reasons of readmission. Death in ICU and at home was uncommon in Hong Kong situation.