• Allison Silverstein, Mercy Butia, Rhahim Bank, Geoffrey Manda, Constance Nyasulu, Noel Mwango, Samuel Makuti, Maria Chikasema, Susan Torrey, Joy Hesselgrave, Jessica Casas, Lameck Thambo, Amos Msekandiana, Msandeni Chiume, Nmazuo Ozuah, and Minke Hw Huibers.
• Global HOPE (Hematology-Oncology-Pediatric-Excellence) Program (A.S., S.T., J.H., J.C., N.O., M.H.H.), Texas Children's Hospital, Houston, Texas, USA; Department of Pediatrics (A.S., S.T., J.H., J.C., N.O., M.H.H.), Baylor College of Medicine, Houston, Texas USA. Electronic address: allison@allisonsilverstein.com.
• J Pain Symptom Manage. 2022 May 1; 63 (5): e473-e480.

ContextOutcomes for children with cancer in sub-Saharan Africa (SAA) are dismal due to delayed diagnosis and limited access to curative therapy. When establishing a pediatric hematology-oncology (PHO) program in low-resource settings, early integration of palliative care services becomes essential. While palliative care is a human right, equitable distribution is lacking.ObjectivesWe aim to describe our experience establishing a palliative care program, the services offered, and the distribution of patients served.MethodsThis is a brief description of our PHO palliative care program in Lilongwe, Malawi at a tertiary care center and a three-year retrospective review of activities (2017-2020). Services offered include inpatient, outpatient, home visits, end of life care, and strengthening of referral systems.ResultsOver the three-year period, 315 patients were enrolled. 57% (n=179) were male. The median age was seven years (5 months-22 years). Patients served were from 17 of 28 districts within Malawi. Diagnoses of patients included 43% solid tumors (n=135), 22% lymphoma (n=68), 15% leukemia (n=47), and 21% hematologic disease (n=65). 40% of patients have died (n=125), with 53% of deaths occurring at home (n=66), 22% in the hospital (n=28), and 25% at unknown locations (n=31).ConclusionPalliative care is a critical component of PHO programs worldwide. Programs must leverage existing networks to ensure optimal care to children and families. We demonstrate the feasibility of integrating palliative care services within a PHO program in a low-resource setting, which could serve as a model for other countries in SSA.Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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