Background The integration of specialized palliative care (SPC) in pediatric oncology aims to minimize the significant suffering experienced by children and families. While early integration of SPC is recommended, barriers to integration of SPC exist and the ways to overcome those barriers are not entirely clear. Procedure We conducted semi-structured interviews of Candian healthcare providers (HCPs) in the fields of pediatric oncology and pediatric palliative care. We performed thematic analysis on the transcripts of those interviews to identify barriers to early SPC integration and solutions to overcome those barriers. Results Eight HCPs were interviewed (4 pediatric oncology and 4 palliative care providers). While the views of HCPs varied about the integration framework (universal, criteria-based, or unguided provider-initiated referrals), the importance of early SPC integration in patients with a high risk of mortality or high symptom burden was consistently described. We identified categories of barriers to early SPC integration including family perception, healthcare team-related, and process/systemic barriers. Common reported barriers include the association of palliative care with death or giving up and the perception that the family is “not ready” to meet SPC. Categories of solutions include improving communication with families, enhancing the collaboration between SPC and oncology teams, and optimizing the referral processes. Participants described strategies that often addressed several categories of barriers. Such strategies include skillful introduction of SPC to families and regular discussions amongst the pediatric oncology and SPC teams. Conclusion Barriers to early integration of SPC can be overcome through thoughtful discussions amongst HCPs. Those strategies should be considered when optimizing SPC integration with the goal of reducing the suffering of children and adolescents with cancer and their families.

10-20% of soft tissue sarcomas cannot be accurately classified with histology and immunohistochemistry (IHC) and require further molecular investigation. We report an unclassified myoid neoplasm in a 5-year-old girl presenting with localized left heel swelling and impaired weight-bearing. Histology and IHC determined this as an undifferentiated sarcoma. Molecular work-up of this soft-tissue lesion demonstrated a novel SRF-MKL2 fusion as well as chromosomal copy number anomalies including 1p, 6q, 22 loss, and 1q gain. Pathologic and molecular features of this tumor fit best in the SRF-rearranged family of cellular myoid tumors. The patient remains disease-free 20 months after margin-negative resection.

Purpose : To determine whether extent of surgical resection of the primary tumour correlates with survival in patients with International Neuroblastoma Staging System (INSS) stage 4, high-risk neuroblastoma. Methods : Data were extracted for patients with newly diagnosed INSS stage 4, high-risk neuroblastoma between 2001-2019 from the national Cancer in Young People in Canada (CYPC) database. Complete resection was defined as gross total resection of primary tumour based on operative reports. Primary endpoints were 3 and 5-year event-free (EFS) and overall survival (OS). Survival analyses were completed using log-rank test and Cox proportional hazards regression including covariates of age, sex, decade of treatment (2001-2009 vs. 2010-2019), immunotherapy, and tandem stem-cell transplant (SCT). Results : One-hundred and forty patients with complete surgical data were included. On univariate analysis, 3-year EFS and OS for patients that had complete vs. incomplete resection was 71% (95% CI 57-80%) vs. 48% (36-60%) and 86% (75-93%) vs. 64% (51-74%), p=0.008 and p=0.002, respectively. 5-year EFS and OS for patients with complete resection also demonstrated significantly improved survival. On Cox Proportional Hazards models adjusted for age, immunotherapy, tandem SCT and surgical resection, only complete resection was associated with statistically significant improved 3 yr EFS and OS, HR=0.48 (0.29-0.81; p=0.006) and HR=0.42 (0.24-0.73; p=0.002). Conclusions : In a large Canadian INSS stage 4 high-risk neuroblastoma cohort, complete surgical resection was associated with increased EFS and OS. Within the constraints of a retrospective study, these results suggest that the ability to achieve primary tumor complete resection in patients with metastatic high-risk disease is associated with improved survival.