Palliative care for children with cancer in Cuba: a narrative review and adaptation of the World Health Organization integration model.
This narrative review applies the WHO pediatric palliative-care integration framework to childhood cancer care in Cuba and identifies gaps in specialist training, home opioid access, formal palliative-care teams, and outcomes research across eight oncology reference centers.
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This narrative review applies the WHO pediatric palliative-care integration framework to childhood cancer care in Cuba and identifies gaps in specialist training, home opioid access, formal palliative-care teams, and outcomes research across eight oncology reference centers.
Research significance
The review supports the inference—not a tested clinical conclusion—that aligning Cuba's pediatric oncology services with the WHO model, including stronger training, multidisciplinary teams, and improved home opioid access, could improve continuity, symptom management, and quality of life; no patient-level intervention or outcome effect is demonstrated.
Source abstract
BACKGROUND: Palliative care for children with cancer represents an urgent health priority in Cuba. The country has a universal and free health system with national coverage, but the systematic provision of specialized pediatric palliative care (PPC) in oncology remains heterogeneous, with significant gaps across the eight pediatric oncology reference centers. OBJECTIVE: To describe the state of PPC development for children with cancer in Cuba, analyze it through the lens of the simultaneous integration model proposed by the World Health Organization (WHO), and identify gaps and opportunities for strengthening. This review is intentionally limited to pediatric oncology; PPC needs of children with non-oncological life-limiting conditions fall outside its scope. METHODS: Narrative review of scientific literature published between 2000 and 2024, normative documents of the Cuban Ministry of Public Health (MINSAP), and reports from international organizations (WHO, PAHO, IAHPC, ALCP). Two authors independently screened identified records; disagreements were resolved by discussion with a third author. The WHO analytical framework for PPC integration was applied to evaluate six key dimensions: policy, education, medicines, services, research, and financing. RESULTS: Cuba has a solid normative basis for PPC, including Ministerial Resolution No. 261/2020 and the National Cancer Control Program. Primary care coverage is universal, and the family doctor system facilitates care continuity, though the current level of formal PC training among family physicians specifically has not been systematically documented. Gaps were identified in: specialized staff training, equitable access to opioids at home, formal constitution of PPC teams in all eight centers, and published clinical research on outcomes in this population. CONCLUSIONS: Cuba has favorable structural conditions for implementing an integrated, high-quality PPC model for children with cancer. The implementation of the National Pediatric Palliative Care Project 2026-2028 represents an important opportunity. Explicit alignment with the WHO model, strengthening specialized training, and generation of national scientific evidence are recommended.