CONTEXT
Our institution is a 367-bed freestanding, quaternary care children’s
hospital.29The Pediatric Hematology/Oncology/Bone
Marrow Transplant teams provide comprehensive care to approximately
180-200 newly diagnosed pediatric oncology patients each year. Our
catchment areas include mainly the states of Missouri and Kansas; we
also receive patient referrals from 7 additional states and the country
of Mexico. Primary oncology teams are comprised of an attending
oncologist, social worker, advanced practice registered nurse (APRN),
and often a hematology/oncology fellow. The palliative care team at our
institution continues to expand, meeting 255 new patients in 2017 and
282 in 2019.
In oncology, the event free survival (EFS) is defined as the length of
time after primary treatment for a cancer ends that the patient remains
free of certain complications or events that the treatment was intended
to prevent or delay30 As the USWNR does not clearly
define refractory cancer and the 5-year EFS is a marker of mortality in
oncology, we used5-year EFS < 50% as our criteria to identify
patients with a higher likelihood of having refractory cancer. We use
the 5-year EFS of <50% to build consensus and create a target
list of patients for whom PPC consult was recommended at diagnosis.