Unmet palliative care needs of a child with cancer in Indonesia

Key points Childhood cancer survival varies greatly between high-income (80%) versus Low and middle-income countries (LMIC) (<20%). To bridge this gap, provision of aggressive curative treatment has been prioritized in latter countries. Palliative care (PC), by contrast, has received little or no attention When children who can no longer be cured from cancer continue aggressive treatment, they may suffer unnecessarily from pain, discomfort and low quality-of-life during prolonged periods In many LMIC, families are often not given the opportunity to participate in decision-making whether they want to extend the life of their children or focus on relieving pain and discomfort This case report illustrates difficulties that Indonesian families may face when their child is diagnosed with cancer, receives intensive chemotherapy despite poor prognosis and severe side-effects, and is not informed about choices of treatment children have during final illness This study highlights the importance to start PC immediately at diagnosis. Both physical and psychosocial wellbeing of patients need to be closely monitored through regular symptom burden assessments. Training on open communication in PC is required in universities and hospitals to enable shared decision-making and improve quality-of-life of children and their families