Pediatric Oncology and Palliative Care

Overall, we now cure 70% of the children who are diagnosed with cancer, and in the 30% of cases that are still not curable, we can almost always add time to the child’s life. As our ability to cure cancer has improved, we are now paying increased attention to the goal of avoiding or alleviating the suffering associated with cancer and its therapy. Risk stratification aims to avoid undertreatment of children with high-risk cancers and to avoid overtreatment (with all of the associated side effects of therapy) of children with lower-risk cancers. This goal has become an important part of designing treatment protocols over the past 15 years. Whether or not a child will be cured, we know that all children with cancer suffer, as do their families. Pediatric oncology is committed to curing cancer, but palliative care is committed to improving a child’s quality of life, irrespective of the potential for cure. Oncology and palliative care are thus twin endeavors, both of which seek what is best for a child and his or her family [1]. Within the 2 broad categories of curing disease and alleviating suffering, there are many specific goals unique to each patient. Palliative care seeks to relieve the physical, emotional, social, and spiritual distress produced by complex, chronic, or life-limiting conditions; to assist in making difficult decisions and setting goals; and to enhance children’s quality of life [2]. More than a decade has passed since the American Academy of Pediatrics [3] and the Institute of