Palliative care services in paediatric oncology centres across Europe: A cross-sectional survey

Background: Palliative care (PC) is an integral part of cancer treatment. However, data on service availability is 
limited in childhood cancers. 

Aim: To describe the availability of PC services in paediatric oncology centres across Europe, and to identify 
barriers and facilitators for implementing and providing paediatric palliative care (PPC). 

Methods: Paediatric oncology centres across Europe were invited to complete an online questionnaire. 
Results: A total of 158 paediatric oncology centres from 27 European countries participated. More than half of the 
centres (n = 102, 64.6 %) reported offering specialised PPC (defined as 24/7 coverage services with a specialised 
physician and a multidisciplinary team). Most centres included a multidisciplinary care team (n = 123, 80.9 %) 
and PC at home (n = 105, 69.1 %). In 38.7 % centres, service capacity was reported to be lower than demand. In 
most centres, PC consultation was initiated for a refractory neoplasm (n = 126, 81.2 %). Few centres (n = 11, 7.1 
%) offered PC consultation at the time of a new cancer diagnosis. Eighty-two centres (52.6 %) reported having 
bereavement services. Negative parental perception (n = 99, 64.7 %) and late referrals (n = 91, 59.5 %) were 
major barriers to implementation perceived by health care providers. 

Conclusion: Our results suggest that specialised PPC is available in more than half of paediatric oncology settings 
across Europe. Although half have had PPC available for > 10 years, many cannot fulfil the demand for service. 
Barriers to implementation (i.e., parental education, staff training) should be addressed, with resources and 
services further expanded to cover the demand for PPC, including bereavement care.