title: Specialist Pediatric Palliative Care Referral Practices in Pediatric Oncology: A Large 5-year Retrospective Audit.
abstract: OBJECTIVE
  To audit referral practices of pediatric oncologists referred to specialist pediatric palliative care services.
  
  
  METHODS
  Retrospective review of medical case records of pediatric palliative care patients over a period of 5 years from January 1, 2010 to December 31, 2014. Descriptive summaries of demographic, clinical variables, and patient circumstances at the time of referral and during end-of-life care were examined.
  
  
  RESULTS
  A total of 1135 patients were referred from pediatric oncology with a gradual increasing trend over 5 years. About 84.6% consultations took place in the outpatient setting. In 97.9% of the cases, parents were the primary caregivers. Availability of specialist pediatric health-care services at local places was available in 21.2% cases and 48% families earned <5000 INR (approximately 73 USD) in a month. Around 28.3% of the referrals were from leukemia clinic and maximum references were late with 72.4% patients having advanced disease at presentation. 30.3% of the referrals were made for counseling and communication and 54.2% had high symptom burden during referral. After referral, 21.2% patients continued with oral metronomic chemotherapy and 10.5% were referred back to oncology services for palliative radiotherapy. Only 4.9% patients had more than 2 follow-ups. 90.8% of the patients were cared for at home in the last days of illness by local general practitioners. 70.6% of the deaths were anticipated.
  
  
  CONCLUSIONS
  Oncologists referred patients late in the course of disease trajectory. Most of the referrals were made for counseling and communication, but many patients had high symptom burden during referral.
authors: Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors: Arunangshu
authors: A
authors: Ghoshal
authors: Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors: Naveen
authors: N
authors: Salins
authors: Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors: Anuja
authors: A
authors: Damani
authors: Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors: Jayita
authors: J
authors: Deodhar
authors: Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors: MaryAnn
authors: M
authors: Muckaden
keywords: Oncology; Paediatrics; Specialist palliative care