Publication
Unidad Nacional de Oncologia Pediatrica (UNOP): A Model for Pediatric Palliative Care in Latin America
Martinez-Jimenez S, Rivas S, McNeil M, Garcia-Quintero X, Rassam R, Irwin L, Antillon F, Gradick K · Journal of Pain and Symptom Management · 2026
Introduction. Despite a high burden of serious illness among children living in Latin America, fewer than 8% of patients in need of pediatric palliative care (PPC) can access services [1, 2]. This study documents demand for palliative services at the Unidad Nacional de Oncologia Pediatrica (UNOP) in Guatemala. UNOP, founded in 2000, treats approximately 500 new patients annually [3]. Common diagnoses in 2024 included leukemias (51%), bone tumors (16%), CNS tumors (10%), retinoblastoma (7%), and lymphomas (4%). The Medicina Integral (MI) team, founded in 2007, delivers PPC at UNOP and has operated its own hospice facility since 2015. Methods. We analyzed data from a retrospective chart review to gauge demand for PPC at UNOP in 2024. This data included unique inpatient and outpatient visits, telemedicine visits, bereavement calls. Results. 3,580 unique palliative encounters occurred, including 157 new consults, 1,688 outpatient visits, 1,168 telehealth visits, 293 hospice admissions, 67 intensive care encounters, 70 survivorship visits, 74 bereavement calls, and 63 encounters for pain management in non-palliative patients. These encounters consisted of symptom management, palliative chemotherapy, diagnostic/prognostic communication, and, unique to this limited-resource setting, crisis support for families considering treatment abandonment. The mortality rate among patients with a new palliative consult was 60% (94/157); median survival was 77 days after referral. Place of death included: home (55%), hospice facility (35%), and hospital (10%). Most families had PPC telephone contact, averaging 2.1 calls per patient; with consistent, positive feedback during bereavement calls. With regard to treatment abandonment, rates were as high as 36 percent in 2007. The MI team developed interventions to alleviate suffering for these families, and rates decreased to 1.6% in 2024. Discussion. This model demonstrates that, even in resource-limited settings, effective PPC can be delivered. This experience serves as a reference for other countries seeking to enhance access to PPC.
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