title: Availability of palliative care services for children with cancer in economically diverse regions of the world.
abstract: OBJECTIVE
  We assessed the availability and quality of palliative care for children with cancer according to national income per capita.
  
  
  METHODS
  We surveyed physicians who care for children with cancer using the Cure4Kids website (http://www.cure4kids.org). Queries addressed oncology practice site; reimbursement; specialised palliative care, pain management and bereavement care; location of death; decision-making support and perceived quality of care. Responses were categorised by low-, middle- and high-income country (LIC, MIC and HIC).
  
  
  RESULTS
  Of 262 completed questionnaires from 58 countries (response rate, 59.8%), 242 were evaluable (55%). Out-of-pocket payment for oncology (14.8%), palliative care (21.9%) and comfort care medications (24.3%) was most likely to be required in LIC (p<0.001). Availability of specialised palliative care services, pain management, bereavement care and institutional or national decision-making support was inversely related to income level. Availability of high-potency opioids (p=0.018) and adjuvant drugs (p=0.006) was significantly less likely in LIC. Physicians in LIC were significantly less likely than others to report high-quality pain control (p<0.001), non-pain symptom control (p=0.003) and emotional support (p=0.001); bereavement support (p=0.035); interdisciplinary care (p<0.001) and parental participation in decisions (p=0.013).
  
  
  CONCLUSIONS
  Specialised palliative care services are unavailable to children with cancer in economically diverse regions, but particularly in LIC. Access to adequate palliation is associated with national income. Programme development strategies and collaborations less dependent on a single country's economy are suggested.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Delgado
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Barfield
authors.forename: Justin N
authors.initials: JN
authors.lastname: Baker
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Hinds
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.forename: Ayda
authors.initials: A
authors.lastname: Nambayan
authors.forename: Yuri
authors.initials: Y
authors.lastname: Quintana
authors.forename: Javier R
authors.initials: JR
authors.lastname: Kane
mesh_terms: D000970:Antineoplastic Agents / Q000600:supply & distribution; D001294:Attitude to Health; D001601:Bereavement; D002648:Child; D002662:Child Health Services / Q000458:organization & administration / Q000600:supply & distribution*; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D005381:Financing, Organized; D014943:Global Health; D006760:Hospitalization; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D010146:Pain / Q000517:prevention & control; D010166:Palliative Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents