• Katharine E Brock, Nicholas P DeGroote, Anna Roche, Annika Lee, and Karen Wasilewski.
• Aflac Cancer & Blood Disorders Center of Children's Healthcare of Atlanta (K.E.B., N.P.D., A.R., K.W.), Atlanta, Georgia, USA; Department of Pediatrics, Division of Pediatric Hematology/Oncology (K.E.B., K.W.), Emory University. Atlanta, Georgia, USA; Department of Pediatrics, Division of Pediatric Palliative Care (K.E.B.), Emory University, Atlanta, Georgia, USA. Electronic address: Katharine.Brock@choa.org.
• J Pain Symptom Manage. 2022 Sep 1; 64 (3): 287-297.e1.

ContextPediatric palliative care (PPC) improves quality of life and end-of-life outcomes for children with cancer, but often occurs late in the disease course. The Supportive Care Clinic (SCC) was launched in 2017 to expand outpatient PPC access.ObjectivesTo describe the inaugural four years (2017-2021) of an academic, consultative, embedded SCC within pediatric oncology.MethodsDescriptive statistics (demographic, disease, treatment, visit, and end-of-life) and change over time were calculated.ResultsDuring the first four years, 248 patients (51.6% male; 58.1% White; 35.5% Black; 13.7% Hispanic/Latino) were seen in SCC, totaling 1,143 clinic visits (median 4, IQR 2,6), including 248 consultations and 895 follow-up visits. Clinic visits grew nearly 300% from year one to four. Primary diagnoses were central nervous system tumor (41.9%), solid tumor (37.5%), and leukemia/lymphoma (17.3%). The first point of PPC contact became SCC (70.6%) for most referred patients. Among the 136 deceased patients (54.8%), 77.9% had a do-not-resuscitate or Physician Orders for Life Sustaining Treatment in place, and 72.8% received hospice care. When known (n = 112), 89.3% died in their preferred location. The time from SCC consultation to death increased from 74 to 226 days over the four years (P < 0.0001). The proportion of SCC consultations that occurred greater than 90 days from death increased from 39.1% in year one to 85.0% in year four.ConclusionEmbedded SCC clinics can be successful, achieve steady growth, improve referrals and timing of PPC, and enhance end-of-life care for children with cancer. Large pediatric cancer centers should include SCC outpatient services.Copyright © 2022. Published by Elsevier Inc.

17 keywords...

hide…