{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T16:50:06Z","timestamp":1754153406410,"version":"3.41.2"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Early integration of palliative care in children with cancer provides a variety of positive effects and is recommended at diagnosis. However, barriers often delay its implementation, and palliative care remains underutilized. This study provides real\u2010world data on palliative care and integration in pediatric oncology in a high\u2010income country.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective observational study, data derived from patients with refractory, progressive, or relapsed malignancies under the age of 18 years were collected from six German pediatric oncology centers (2017\u20132022). In addition to palliative data (onset, and duration of palliative care services, frequency of contact, place of death), disease entity, relapse\/progression frequency, Karnofsky Performance Scale Index, therapy, and overall survival were collected. The frequency, timepoint of initiation and the duration of palliative care services were examined in relation to the disease trajectory (diagnosis to death\/censoring) and tumor entity. Outcomes (overall survival, Karnofsky Performance Scale Index, place of death) were analyzed based on palliative care status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Only 157 (42%) of the 373 patients received palliative care services. The mean duration of palliative involvement was 6.0 months with a mean disease trajectory of 31.4 months for patients receiving palliative care. On average, palliative care was initiated in the last third of the disease trajectory. Most of the 157 patients (65.9%) received palliative care during their final relapse\/progression and only 16.8% at diagnosis. There was a significantly lower frequency of palliative care involvement for children with hematological malignancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite the substantial benefits, this study highlights significant delays and underutilization of palliative care for pediatric oncology patients, even in a high\u2010income country.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.31870","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:15:13Z","timestamp":1750896913000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Raising Awareness: Real World Data On Palliative Care for Advanced Pediatric Cancers in Bavaria"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6073-6464","authenticated-orcid":false,"given":"Nadja","family":"Nehls","sequence":"first","affiliation":[{"name":"Department of Pediatrics and 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Kinderklinik M\u00fcnchen Schwabing Technical University of Munich  Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Haller","sequence":"additional","affiliation":[{"name":"Institute of AI and Infromatics in Medicine TUM School of Medicine and Health Klinikum rechts der Isar Technical University of Munich  Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicitas Ferrari\u2010von","family":"Klot","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Children's Cancer Research Center TUM School of Medicine and Health Kinderklinik M\u00fcnchen Schwabing Technical University of Munich  Munich Germany"},{"name":"Pediatric Oncology Network KIONET BAVARIA  Bavaria Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Metzler","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Network KIONET BAVARIA  Bavaria Germany"},{"name":"Bavarian Cancer Research Center (BZKF)  Bavaria Germany"},{"name":"Pediatric Oncology and Hematology Department of Pediatrics and Adolescent Medicine University Hospital Erlangen  Erlangen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8237-1854","authenticated-orcid":false,"given":"Michael C.","family":"Fr\u00fchwald","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Network KIONET BAVARIA  Bavaria Germany"},{"name":"Bavarian Cancer Research Center (BZKF)  Bavaria Germany"},{"name":"Swabian Children's Cancer Center Pediatrics and Adolescent Medicine University Medical Center Augsburg  Augsburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul\u2010Gerhardt","family":"Schlegel","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Network KIONET BAVARIA  Bavaria Germany"},{"name":"Bavarian Cancer Research Center (BZKF)  Bavaria Germany"},{"name":"Department of Pediatrics Section of 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