# Early Versus Late Pediatric Palliative Care in Oncology: A Systematic Review of Outcomes, Disparities, and Implementation Barriers: Palliative Care in Oncology

## TL;DR

This review finds that starting palliative care early in children with cancer improves outcomes and reduces aggressive end-of-life treatments.

## Contribution

The study systematically compares early versus late palliative care in pediatric oncology, highlighting disparities and barriers to implementation.

## Key findings

- Early palliative care reduces ICU use and improves quality of life in pediatric oncology patients.
- Minority groups and patients with blood cancers are less likely to receive early palliative care.
- Integrated home-hospital models lower hospital-based end-of-life care effectively.

## Abstract

This systematic review, conducted per PRISMA 2020 guidelines, synthesizes
evidence on early pediatric palliative care (PPC) versus late or no PPC in
children and young adults (0–21 years) with life-threatening oncologic
illnesses. A comprehensive search of MEDLINE, Embase, Scopus, PsycINFO, Web of
Science, Cochrane Central, and grey literature (ProQuest, ClinicalTrials.gov)
from inception to 1 August 2025 identified 12 studies, including retrospective
cohorts, surveys, and one randomized controlled trial across the USA, Canada,
Taiwan, and Spain. Early PPC, variably defined as initiation from diagnosis to
12 months before death, consistently reduced end-of-life care intensity (fewer
ICU admissions, mechanical ventilation, invasive interventions), increased
hospice enrollment, home deaths, and improved quality of life and symptom
management compared to late or no PPC. Disparities were evident, with minority
groups and patients with hematologic malignancies less likely to receive early
PPC, compounded by barriers such as provider misconceptions, systemic
limitations, and clinical trial enrollment delays. Outpatient and integrated
home-hospital PPC models significantly lowered hospital-based end-of-life care,
though robust late PPC programs could achieve comparable outcomes. Narrative
synthesis using the GRADE approach highlighted moderate to high confidence in
reduced care intensity and improved family outcomes with early PPC, despite
heterogeneous definitions and study designs precluding meta-analysis. Findings
show the need for standardized PPC protocols, education to address provider
barriers, and policy reforms to enhance equitable access, particularly for
underserved populations. While oncology evidence is robust, further randomized
trials are needed to strengthen findings across other conditions, supporting
early PPC integration to optimize patient and family outcomes in pediatric
oncology.