Joanne Wolfe, MD, MPH
Advances in pain and palliative care for adults have been significant
in the past decade due in part to increased recognition, support and
use by caregivers and patients. While acknowledging that lessons from
adults can be borrowed to help pediatric patients, an international team
of pediatric palliative care specialists is also calling for increased
research to address children's differing physical, psycho-social and
In a review article to be published by the journal Lancet on
its Web site on Aug. 16, and later in a print edition, Joanne Wolfe,
MD, MPH, of Dana-Farber Cancer Institute and Children's Hospital Boston
and her coauthors outline steps to further the development of pediatric
palliative care standards and objectives.
"Emerging data from our research suggest that there are a lot of
opportunities for improvement in the area of pediatric pain and
palliative care," explained Wolfe, the paper's senior author. "If we do
not become a community of interested individuals moving this field
forward, there isn't going to be the opportunity systematically to
figure out ways to do a better job of taking care of these children and
Pediatric palliative care focuses on ensuring the best possible
quality of life for children whose illness makes it likely that they
will not live to become adults, and focuses on the physical, emotional,
social and spiritual needs of the child as well as supporting the
In the United States there are over 300,000 children living with
complex chronic conditions that may lead death in childhood or premature
death and who may benefit from palliative care.
The authors reviewed the use of palliative care world-wide and
identified limitations based on access to care and resources. They cited
six challenges that must be addressed to further the field of pediatric
- Clearly defining pediatric palliative care
- Better understanding the needs of children with life-threatening conditions and their families
- Developing an approach to pediatric palliative care that will be appropriate across different communities
- Reducing suffering, and promoting hope and healing
- Acknowledging professionals' responses and needs for support
- Promoting needed changes by cultivating educational programs
"Annually, 55,000 children die, but there are so many more kids
living day to day," said Wolfe, who is also an assistant professor of
pediatrics at Harvard Medical School. "Along with care focused on their
underlying illness, we also need to focus on their quality of life,
comfort, day-to-day living, because they may not live to adulthood."
The study was funded by the National Cancer Institute and a Child Health Research Grant from the Charles H. Hood Foundation.
The study's other authors are Stephen Liben, MD, Montreal Children's
Hospital of the McGill University Health Center in Montreal, and Danai
Papadatou, PhD, University of Athens, Greece.
Dana-Farber Cancer Institute (www.dana-farber.org)
is a principal teaching affiliate of the Harvard Medical School and is
among the leading cancer research and care centers in the United States.
It is a founding member of the Dana-Farber/Harvard Cancer Center
(DF/HCC), designated a comprehensive cancer center by the National