High symptom burden in children with cancer and high parental satisfaction: why the disconnect?

Pediatric palliative care (PC) has emerged over the past two decades as an approach aiming to ease suffering for children and their families coping with life-threatening illness, and has become increasingly integrated, concurrently, with disease-directed care. There is also recognition of the need for improved PC services in low- and middle-income countries. While most innovations occurring in PC are taking place in industrialized countries, over 90% of global child cancer deaths occur in low- and middle-income countries (1). Barriers to care include delayed diagnosis, limited access to therapies, insufficient and undertrained personnel and lack of infrastructure (2). Where services do exist, financial barriers may remain a significant concern (3). Especially frustrating is that access to even relatively inexpensive and easy to use treatments, such as morphine, remains inadequate due to both concrete and conceptual barriers (2,3).