**7. Palliative care**

Palliative care for children has evolved, over the last two decades, as separate specialized entity. Its delivery encompasses the total care of children with life-limiting diseases, regard‐ less of outcome. It is worth noting that palliative care is applicable from the time of diagno‐ sis, through active and curative treatment, and afterwards. Timing is further complicated by the perceived sharp division between curative therapy and palliative care among pediatric oncologists and parents who view palliative care as giving up hope and representing failure.

Palliative care service includes improved communication and continuity of care across different disease and management stages. This care deals with assessment of physical, psychosocial, emotional, and spiritual needs, provision of comprehensive specialized pain and symptom management, and support with complex and ethical decision making. It is also concerned with enhanced awareness of diverse cultural beliefs about dying and death, specialized care of the dying patient, and provision of bereavement care. Education and staff support to improve delivery of care and respond to moral distress are additional important role [78, 79]. Palliative care services must better be organizationally situated within a pedia‐ tric oncology program. Without early integration of palliative care, the focus of care then centers on life-prolonging measures, which may result in painful and invasive procedures, additional unnecessary suffering, and futile resuscitation. Care may be missed if not ad‐

dressed early in the trajectory of a cancer illness when death is expected. However, the pediatric brain tumor palliative care introduction time remains unclear and controversial, and has little evidence for practice guidelines [78].
