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Barriers to Palliative Care Integration for Children With Cancer Across Asia Pacific

Cuviello A 1 , Salek M 2 , Handayani SA 2 , Blair S 2 , Chandra A 3 , Job G 2 Show all authors , Ehrlich BS 4 , Chandra L 5 , Drake R 6 , Gunasekera S 7 , Kakazu M 8 , Kang SH 9 , Leão LMDR 10 , Mahajan A 11 , Miranda MC 12 , Moe T 13 , Mynak ML 14 , Nguyen HTK 15 , Rasheed E 16 , Sipai S 17 , Souvalansy B 18 , Sripornsawan P 19 , Tan TSZ 20 , Teh KH 21 , Yotani N 22 , Lee Ai C 23 , Bagai P 24 , Bee OG 25 , Bravo S 12 , Buang SNH 26 , Bui HTT 27 , Choden T 14 , Giri BR 28 , Graetz DE 2 , Gupta H 24 , Poh Heng C 29 , Kaye EC 2 , Khaiman C 30 , Khaing AA 31 , Kim MS 32 , Kurniati N 33 , Laughton S 34 , Mlis R 35 , Ngoc LB 36 , Quintero XG 2 , Rios D 2 , Dos Santos MML 10 , Sapkota S 17 , Sari TT 33 , Sharma KS 37 , Sorrosa R 12 , Tabjaroen S 38 , Wahyuni R 5 , Watanabe K 39 , Yandana S 2 , Yi Yi W 26 , Zaki MA 16 , Devidas M 2 , Baker JN 3 , McNeil MJ 2 , Agulnik A 2 , Lam CG 2

Affiliations 

  • 1 Phoenix Children's Hospital, Phoenix, AZ
  • 2 St Jude Children's Research Hospital, Memphis, TN
  • 3 Stanford University School of Medicine, Palo Alto, CA
  • 4 Boston Children's Hospital, Boston, MA
  • 5 Rachel House (Yayasan Rumah Rachel), Jakarta, Indonesia
  • 6 Queensland Children's Hospital, Brisbane, Australia
  • 7 National Cancer Institute, Maharagama, Sri Lanka
  • 8 Japan Heart Medical Center, Udong, Cambodia
  • 9 Asan Medical Center Children's Hospital, Seoul, South Korea
  • 10 National Hospital Guido Valadares, Díli, Timor-Leste
  • 11 Indraprastha Apollo Hospitals Delhi, Delhi, India
  • 12 Southern Philippines Medical Center, Davao City, Philippines
  • 13 Yangon Children's Hospital, Yangon, Myanmar
  • 14 Jigme Dorji Wangchuck National Referral Hospital, Ministry of Health, Thimphu, Bhutan
  • 15 Hue Central Hospital, Hue, Vietnam
  • 16 Hulhumalé Hospital, Hulhumalé, Maldives
  • 17 Kanti Children's Hospital, Kathmandu, Nepal
  • 18 Children's Hospital, Vientiane, Laos
  • 19 Prince of Songkla University, Hat Yai, Thailand
  • 20 National University Children's Medical Institute, Singapore, Singapore
  • 21 Hospital Tunku Azizah, Kuala Lumpur, Malaysia
  • 22 National Center for Child Health and Development, Tokyo, Japan
  • 23 University Malaya, Kuala Lumpur, Malaysia
  • 24 CanKids KidsCan, Delhi, India
  • 25 Sabah Women and Children Hospital, Sabah, Malaysia
  • 26 KK Women's and Children's Hospital, Singapore, Singapore
  • 27 VinUniversity Hanoi, Ha Noi, Vietnam
  • 28 WHO Regional Office for Southeast Asia, New Delhi, India
  • 29 HCA Hospice Care, Singapore, Singapore
  • 30 Chulalongkorn University, Bangkok, Thailand
  • 31 University of Medicine, Maharagama, Myanmar
  • 32 Seoul National University Hospital, Seoul, Republic of Korea
  • 33 Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • 34 Starship Blood and Cancer Center, Auckland, New Zealand
  • 35 Calmette Hospital, Phnom Penh, Cambodia
  • 36 Vietnam National Children's Hospital, Hanoi, Vietnam
  • 37 B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal
  • 38 Thai Pediatric Oncology Group, Bangkok, Thailand
  • 39 Asian Children's Care League, Tokyo, Japan
JCO Glob Oncol, 2026 Apr;12(4):e2500512.
PMID: 41985116 DOI: 10.1200/GO-25-00512

Abstract

PURPOSE: Early integration of palliative care (PC) for children with cancer is vital to improved patient outcomes. Despite this, access to PC services for children in Asia Pacific (AP) is sparce. We aimed to explore potential barriers to PC provision in childhood cancer care across AP.

METHODS: The Assessing Doctors' Attitudes on Palliative Treatment survey was revised for cultural context, translated into six languages, and distributed electronically to physicians who care for children with cancer. Descriptive statistics were used to summarize data. Secondary analyses used the Pearson chi-square test or Fisher exact test to examine associations between prior PC training and physician subspecialty with reported barriers. The McNemar test was applied to evaluate differences between actual versus ideal timing of PC consultations. Analysis of variance was conducted to compare mean values for perceived barriers across country income levels.

RESULTS: Six hundred twenty-one physicians from 18 countries participated, with an overall response rate of 27% (621/2,305) and a median country response rate of 30% (range, 11%-85%). Most respondents (n = 366; 59%) believed PC should be consulted at diagnosis, but only 18% (n = 117) stated that this occurred in their clinical setting (P < .001). The most highly ranked barriers to PC provision included limited physician knowledge (n = 511; 82%), lack of national health policy/advocacy (n = 494; 79%), lack of PC-trained clinicians (n = 492; 79%), lack of home-based services (n = 487; 78%), and physician discomfort in discussing PC (n = 483; 78%). Physicians practicing in lower-middle-income countries rated these barriers more significantly.

CONCLUSION: Physicians report a discrepancy between ideal and actual timing of PC integration and identify several barriers to PC provision. Study findings will inform capacity building, education, and advocacy initiatives to improve the timing and quality of PC delivery in the region.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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