Incorporating palliative care services within oncologic care is receiving international recognition with notable benefits for patients and health-care systems.

The introduction of comprehensive and community-based palliative care services in Canada resulted in increased palliative care service delivery and cost neutrality, primarily achieved through a decreased use of acute care beds.99

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A multicenter study examining resource consumption and costs of palliative care in Spain revealed reduction in hospital stay duration, an increase in the death-at-home option, a lower use of hospital emergency rooms, and an increase in programmed care.100

This Spain-based study reported a total cost saving of 61% with greater efficiency and no compromise of patient care.100

Around the same time, two urban US hospitals compared costs of palliative care integration with those of usual care.101 Palliative care was associated with significantly lower likelihood of intensive care service use and lower inpatient costs compared with usual care.101

In three African countries, investment in palliative care community training as part of a public health model has improved access to services while reducing families’ perceived physical, financial, and emotional burdens.102 Each of these findings speaks to both a cost and quality incentive for hospitals to develop and foster palliative care programs.

This article describes the important role of education and training for all countries embracing earlier integration of palliative concepts into care practices. The Clinical Oncological Society of Australia (COSA) illustrates an ideal way for countries to engage in this process, beginning with a designated agency to oversee implementation. 

COSA supports the formation of a federally funded national palliative care agency charged with developing Australia’s capacity to provide quality palliative care to all Australians in need of palliative care regardless of their life stage and care setting.

They recognize the integration of palliative care as a fundamental part of cancer care including care provision, education, training, and research. This includes providing education in quality palliative care to general practitioners within the community, as well as financial incentives for time spent on palliative care training.

This agency is responsible for overseeing palliative care standards, funding, access, education, and research in Australia by promoting the value of palliative care to the community and facilitating education of the health-care workforce in the practice of quality palliative care.103

Palliative care training requires upfront investment for curricular development and professional development programs, although these investments are recognized to be cost-saving in the long run.

In the U.S., a state-sponsored palliative network depicted the upfront fees as “relatively low cost” as compared with long-term impact.104

Integration of staff trained in palliative care, such as placement of advanced practice palliative care staff at critical transitions, was described as a low-cost intervention with high-cost savings in assisting with home care transitions and minimizing intensive care admissions.105

Access to palliative trained providers via a 24-hour telephone service was labeled “economically viable” with presumed spared emergency room visits and significant improvement in family comfort.106 Palliative care training may be considered an upfront investment with multiplier impacts.


The importance of competent, confident, and compassionate providers for AYAs warrants the development of effective educational strategies for teaching AYA palliative care.

As the AYA age spectrum represents sequential transitions through developmental stages, trainees experience changes in their learning needs during their progression through sequential phases of training. Seasoned general practitioners recognize palliative care as a skill set acquired through lifelong exposure and education.107

As Wein et al64 eloquently stated, “Incorporating AYAs into a single psychosocial group necessarily involves squeezing a heterogeneous population into a square box, though many similarities exist.”

We envision palliative care education as a means of quilting together these varying fabrics – a sewing together of square boxes – for the provision of comforting, practical palliative care.


This work was supported in part by the Intramural Program of the National Cancer Institute, Center for Cancer Research; ONS Foundation/Genentech, Inc.; and the Kids with Cancer Foundation Australia. 

Lori Wiener,1,*,# Meaghann Shaw Weaver,2,3,*,# Cynthia J Bell,4,# Ursula M Sansom-Daly,5–7

1Pediatric Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA; 2Department of Oncology, Children’s National Health System, Washington, DC, USA; 3Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN, USA; 4College of Nursing, Wayne State University and Hospice of Michigan Institute, Detroit, MI, USA; 5Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia; 6Discipline of Paediatrics, School of Women’s and Children’s Health, UNSW Medicine, The University of New South Wales, Kensington, NSW, Australia; 7Sydney Youth Cancer Service, Sydney Children’s/Prince of Wales Hospitals, Randwick, NSW, Australia

*These authors have contributed equally to this work 

#On behalf of the Pediatric Palliative Care Special Interest Group at Children’s National Health System 


The authors report no conflicts of interest in this work. 


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