10055 Background: Globally around 21 million children require pediatric palliative care yearly of whom more than 97-98% of the children in greatest need live in low- and middle- income countries. Nevertheless, presently, only around 5-10% of children and their families in those situations receive palliative care while the development of pediatric-specific palliative care frameworks and services remains very much less developed than adult palliative care in many health systems. Methods: A systematic search was performed in PubMed database, Embase database and Global Health for studies published between 2015 and 2025 using PRISMA guidelines. Inclusion criteria: Original research on the models of PPC, access to opioids or educational interventions in the context of LMICs. Articles were screened for inclusion by two independent reviewers and were evaluated for quality using the MMAT. Data have been synthesized with the help of a thematic framework. Results: Out of the 427 identified records, 48 studies in 32 countries met the inclusion criteria. Important barriers identified were restrictive legislation, and 68% of the studies mentioned "opiophobia" and legal barriers to access of pediatric morphine, median morphine consumption in LMICs less than 1% of high income countries. While workforce deficit only of 12% of LMIC children's or pediatric doctors (pediatricians) reported some type of formal training in PPC during residency. Also, financial toxicity: End-of-life care financial costs for families in LMIC often outweigh cost up to, or more than, 50% of their yearly income. On the other hand, successful enablers were task-shifting to community health workers and integration of PPC into existing oncology protocols. Quantitative synthesis demonstrated the use of integrated hospital in-home models to decrease emergency room visits by 35% in the last month of life. Conclusions: Large disparities still exist in PPC provision in LMICs, which is related to regulatory and educational gaps. But some localized "hub-and-spoke" models provide an outline of how to integrate in a sustainable fashion. For ASCO's global mission, these findings indicate that "Zero Pain" initiatives require pediatric specific legislative reform and mandatory oncology palliative training to address the gap in quality of survival.
Siddiqui et al. (Wed,) studied this question.