Palliative care in cancer — formative SAQs

Formative SAQs on palliative care in childhood cancer: the World Health Organization definition and the concurrent parallel model, the early referral at the diagnosis of the high-risk disease, the World Health Organization analgesic ladder and the opioid stewardship for the cancer pain, the goals-of-care and advance care planning conversation, and the bereavement follow-up and the sibling support.

Prompt

Integrating palliative care in the child with cancer: the definition, the early referral, the symptom control, the goals-of-care conversation and the bereavement

SAQ 1 (10)

An eight-year-old girl with relapsed medulloblastoma is admitted with a severe pain flare, her parents exhausted after months of treatment and frightened by her deterioration. The oncology team is weighing another line of disease-directed therapy against the burden it will bring. [2] [4]

a) Give the World Health Organization consensus definition of palliative care, and explain why the integrated concurrent model that runs the palliative care alongside the disease-directed therapy is preferred to the sequential model that defers it to the moment the curative treatment fails. (3 marks) [1][2]

b) Outline the structured symptom assessment you would perform across the four dimensions of suffering, naming the validated tools you would use and the place of the family's proxy report. (3 marks) [4][2]

c) The child's pain is uncontrolled. State the principles of the World Health Organization analgesic ladder, how you would calculate the breakthrough opioid dose from the background, and the circumstances and the method for an opioid rotation. (2 marks) [3]

d) Outline the goals-of-care and advance care planning conversation you would hold with the family at this turning point, and the documents that would carry the plan. (2 marks) [2][6]

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You have read the opening of this SAQ. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References6Show ledger

[1]Radbruch L, De Lima L, Knaul F, et al. Redefining Palliative Care-A New Consensus-Based Definition. J Pain Symptom Manage, 2020.PMID 32387576
[2]Snaman JM, McCarthy S, Wiener L, et al. Pediatric Palliative Care in Oncology. J Clin Oncol, 2020.PMID 32023163
[3]Zernikow B, Smale H, Michel E, et al. Paediatric cancer pain management using the WHO analgesic ladder--results of a prospective analysis from 2265 treatment days during a quality improvement study. Eur J Pain, 2006.PMID 16243549
[4]Wolfe J, Grier HE, Klar N, et al. Symptoms and suffering at the end of life in children with cancer. N Engl J Med, 2000.PMID 10655532
[5]Barrera M, Alam R, D'Agostino NM, et al. Parental perceptions of siblings' grieving after a childhood cancer death: a longitudinal study. Death Stud, 2013.PMID 24600719
[6]Johnston EE, Rosenberg AR Palliative Care in Adolescents and Young Adults With Cancer. J Clin Oncol, 2024.PMID 37862672