Comparison of early versus late palliative care integration in pediatric onco-critical care: Single-center retrospective study from South India

Background: Children with life-limiting illnesses in onco-critical care often face severe symptoms and complex end-of-life decisions. Early palliative care (PC) may enhance symptom management, quality of life (QOL), and resource utilization. This study aimed to compare clinical and economic outcomes of early versus late PC in pediatric onco-critical care. Subjects and Methods: This was a retrospective analysis of children aged 1 month to ≤18 years with hemato-oncologic diseases or undergoing hematopoietic stem cell transplantation (HSCT) admitted from July 2022 to June 2025. PC was integrated through the onco-critical care and pediatric oncology teams for high-risk children. High-risk children included those with advanced disease, severe symptom burden, or preexisting organ dysfunction. Early PC was initiated within 48 h of pediatric intensive care unit involvement; late PC was initiated after 48 h. Outcomes included symptom control, mechanical ventilation, intensive care unit involvement (ICU) length of stay, mortality, and costs. Results: Out of 71 children, 51 (72%) received early PC. Early PC significantly lowered pain scores (2.1 ± 0.9 vs. 5.8 ± 1.2; P < 0.0001), enhanced symptom control ( P < 0.05), and decreased the need for mechanical ventilation by 55% (odds ratio OR =0.45; 95% confidence interval CI: 0.30–0.80; P = 0.002). It also reduced ICU mortality (adjusted OR = 0.72; 95% CI: 0.52–0.96; P = 0.01), shortened ICU stay by 2.6 days, and lowered costs by approximately ₹60,000 per patient. Multidisciplinary counseling achieved 80% adherence to NICE guidelines. Conclusions: Early, integrated PC enhances symptom management, decreases invasive procedures and ICU mortality, and reduces costs for high-risk pediatric oncology and HSCT patients.