Rev. Bras. Hematol. Hemoter. vol.36 número6

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rev bras hematol hemoter. 2014;36(6):388–389

Revista

Brasileira

de

Hematologia

e

Hemoterapia

Brazilian

Journal

of

Hematology

and

Hemotherapy

w w w . r b h h . o r g

Scientific

comment

Scientific

comment

on

the

theme

of

palliative

care

in

pediatric

hematological

oncology

patients

夽

Momcilo

Jankovic

∗

UniversityofMilano-Bicocca,FondazioneMonzaeBrianzaperilBambinoelasuaMamma,SanGerardoHospital,Monza,Italy

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Articlehistory:

Availableonline16September2014

Someofthemostrelevantaspectsinthecareofchildrenwith

life-limitingillnesses (particularlythosewithoncologic

dis-eases)concerntheteamandthecaresetting,thedailylife,

bereavementmanagementandthepossibilityofcasereview

afterdeath.

Themain goal of pediatric palliative care(PPC) is

fam-ily centered homecare which requires the presence of an

experienced,andstructuredinterdisciplinaryteam.The

coop-eration,generallyspeakingindifferentcountries,betweenthe

hospitalandthelocalhealthservicesisquitepoor:local

pedia-triciansareinvolvedinalowpercentageofcasesandrarely

attendchildrenintheterminalphase.1

The hemato-oncologist often remains the only referral

physician. Usually, althoughhome care(if present) is

pro-posed,manyfamiliesrefuse.However,theliteraturesuggests

thatdeathathomeisconsideredthefirstchoice,butthis

hap-pensmorefrequentlyonlywhenanintegratedpalliativecare

teamisavailabletosupportfamilydecisionsandcontaintheir

fearofbeingabandoned.2

Themainobstaclestohavinghomecarearereportedlythe

physicians’impressionthatthepatient’sclinicalmanagement

isexcessivelydifficult,theparents’fearofabandonmentorthe

ethnicalandsubsequentlanguageproblemofparents.

DOIoforiginalarticle:http://dx.doi.org/10.1016/j.bjhh.2014.09.003.

夽

SeepaperbyValadaresetal.onpages403–8.

∗ _{Corresponding}_author_at:_Division_of_Pediatrics,_University_of_{Milano-Bicocca,}_Foundation_“Monza_e_Brianza_per_il_Bambino_e_la_sua

Mamma(MBBM)”,SanGerardoHospital,Monza,Italy.

E-mailaddress:[email protected](M.Jankovic).

ThemostimportantbarriertotheimplementationofPPC

isprobablythelackofintegrated,structuredand dedicated

teamswhichcouldcoordinatePPCnetworks.Somepolicies

couldbeproposed:3

(a) moretrainingforphysiciansandnursesonpalliativecare

including: formal education, as part ofmedical degree

courses, and an adequate period of experience in a

palliativecareserviceduringpediatricresidenciesforall

pediatricians,aswell as educationalcoursesand

train-ingperiodsfornurses.Thefinalaimwouldbetoaddress

thesetopicsinhospital,inthelocalhealthsystem,andin

hospices.

(b) PPCNetworksand/orpediatrichospicesneedtobe

cre-atedtostrengthen thelinkbetweenhospitalsandlocal

services.

(c) Agreaterpromotionofmultispecialtynetworksisneeded,

including palliative care specialists, local pediatricians,

psychologists and nurses working in close cooperation

withpediatric oncology centers inorder to share

deci-sionsconcerningpatientcareand transformthefailure

ofcancertreatmentintothecontinuationofappropriate

patientcare,providingallthesupportneededbyterminal

patients.

http://dx.doi.org/10.1016/j.bjhh.2014.09.006

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revbrashematolhemoter.2014;36(6):388–389

389

These policiesshould berequested because, stilltoday,

manychallengesexistintheimplementationofthese

inte-gratedmodelsincludingthepressuretoreduceoverallhealth

carecosts,healthcareproviderslackofnecessarytoolsand

skills,and themistaken tendencyto equatepalliative care

withend-of-lifecare.Despitethefactthatpalliativecareis

nowwidelyrecognizedasacriticalpartofexcellentcarefor

childrenwithlife-limitingdiseases suchascancer,patients

continuetoreceivethiscareverylateintheirillness

trajec-tory.However,asevidencegrowsthatintroducingpalliative

careearlyinthecourseoftherapybenefitschildrenwith

can-cer,andasthemedicalculturebecomesmoreawareofthe

evidencedemonstratingthevalueofsuchanapproach,

pedi-atriconcology and palliative care willcontinue to become

moreintegrated.Thiswillbenefitchildren,theirfamilies,and

thestaffmemberswhocareforthem.

In this issue ofthe Revista Brasileira de Hematologia e

Hemoterapia,Valadaresetal.reportontheexperienceofa

tertiaryhospitalinBrazil.4

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1.BeniniF,FerranteA,PòC,ScaraniR,MalvezziA,LeoniV,etal. Endoflifecareinchildrenwithcancer:anationalsurveyfrom theItalianAssociationofPediatricHematologyandOncology (AIEOP).PediatrAnesthCritCareJ.2014;2(1):55–64.

2.BarfieldR.Pediatriconcologyandpalliativecare.NCMedJ. 2014;75(4):276–7.

3.SteeringCommitteeofthe,EAPC,taskforceonpalliativecare forchildren,adolescents.IMPaCCT:standardsforpaediatric palliativecareinEurope.EurJPallCare.2007;14(3):

109–14.