In a recent study, Logan Cole Houston, MD, and colleagues from the University of Tennessee Health Science Center in Memphis evaluated the access to pediatric palliative care services in resource-constrained communities for patients in hematology/oncology. Pediatric palliative care can improve communication, enhance quality of life, and reduce suffering for children with cancer. The authors used data from the 360-degree evaluation tool Pediatric Oncology Facility Integrated Local Evaluation (PrOFILE) to assess the care capacity and development of improvement strategies within pediatric institutions globally. 

Dr Houston and colleagues pulled data from 112 institutions in 23 different countries around the world that completed the abbreviated PrOFILE from the years 2019 to 2021. They also used questions about pediatric personnel and training, symptom management questions, and patient outcomes for their data on accessibility and efficacy of care. Then, the results were stratified by world bank income level. 

The 112 hospitals were classified as follows: 6 were low income (LIC), 34 were lower-middle income (LMIC), 55 were upper-middle income (UMIC), and 17 were high income (HIC). Nineteen percent of the hospitals were primarily cancer oriented, 22% were children’s hospitals, 45% were general hospitals, and 12% were pediatric oncology institutions. They also found that patient access to specialists was different based on their income level: HIC had 71% access, UMIC had 41%, LMIC had 32%, and LIC had 17%. Patients with higher income levels were more likely to have access to a specialist than a patient with a lower income level. Specialists in HIC countries were also found to have a higher likelihood of a formal education specifically in pediatric cancer (59%) in comparison to specialists from LIC or LMIC countries. HIC hospitals also had 100% access to oral morphine, while UMICs had 76%, LMICs had 27%, and LICs only had 33% access. Similar results were reported with injectable morphine, with 100% of HICs, 96% of UMICs, 41% of LMICs, and 33% of LICs reporting almost always having availability. At least 50% of institutions in each income level reported almost always having access to ibuprofen, acetaminophen, dexamethasone, ondansetron, metoclopramide, omeprazole, diazepam, phenobarbital, and phenytoin. Higher availability of end-of-life services was found in HIC institutions (53%) than in UMICs (36%), LMICs (18%), and LICs (17%). After completing the PrOFILE tool, 50% of institutions established plans for improvement in supportive, palliative, and/or end-of-life care. 

“Despite increased need for palliative services in LMICs, there is less access to trained providers and essential medications, especially in those with decreased resources,” wrote the authors.

In conclusion, access to pediatric palliative care services varies by the patient’s income level. Those in higher income level communities have higher levels of access to specialists and specific medications. The authors believe the results from their assessment will help implement future improvements in institutions providing pediatric care.

Houston LC, McNeil M, Le MA, Forrest H, Gonzalez-Guzman M, Friedrich P. A global assessment of access to pediatric palliative care for children with cancer in resource-constrained settings. Presented at: the 2023 ASCO Quality Care Symposium; October 27-28, 2023; Boston, MA, and virtual; Abstract 87.