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.