Subhita
India's First Pediatric Palliative Care Centre

Pediatric palliative care is an active and total approach to care, embracing physical, emotional, social and spiritual elements. It focuses on enhancing quality of life and includes the management of distressing symptoms and provision of respite and care from diagnosis through treatment and, where necessary, into death and bereavement. 

At most hospitals in India even if Pediatric Cancer Units exist, with the large burden of patients and scarce resources, there is limited if no emphasis on symptom management, pain management or counseling support. The gap becomes even more acute when a child becomes terminally ill and there is no further cure.  

Sometimes there may be a Pain and Palliative Care unit at the hospital, but there could be the absence of team coordination between the Pediatric Cancer Unit and the PPCP, the emergency center or the hospice. A child’s transition back home, and even into death may thus be painful, traumatic and the end of the road for the family may be a lonely, bitter struggle.

The need for a Pediatric Palliative Care Centre (PPCC) was identified as an integral part of CanKids objective to improve the quality of life for cancer children and their families. 

​It is essential to fill a gap in provision of pediatric palliative care in India, in June 2012, Cankids opened India’s first pediatric day care and transition home in Gautam Nagar.

Centre Features:

• Two floors with ten cubicles
• Inpatient care, outpatient care ,day care and an emergency bed
• Palliative medical support facilities
• Pain management and symptom relief
• Physiotherapy clinic
• Recreation &  complementary therapy room,
• Psychological Counseling 
• Learning Activity Clinic
• Training Center

PPCC Subhita is a Holistic Model to provide comprehensive Palliative and Supportive Care for Children with Cancer. It’s a 24 hour, 10 bedded,  a one-stop Multidisciplinary IPD and OPD service which provide the palliative care support right from the moment of diagnosis through the treatment and thereafter:

• When the child is in pain and the diagnosis or treatment is yet to start.
• When symptoms are uncontrolled, fatigue, breathlessness, difficulty in swallowing, ulcer, loss of appetite, depression and grief.
• Psychological counseling for the child and the family at all stages of the cancer journey.
• When the treating Doctor has said that there is no further treatment- at this stage full palliative care services for the child and the family.

We also support the child to return home when there is no further cure however our center is fully equipped to provide care for the child even in their last moments.  

Eligibility Criteria for Admissions:

• Any member of CanKids team or Referring Doctors’ team may refer a child for assessment and management of pain, symptoms or psycho-social problems at PPCC. Referrers should contact the Doctor or Nurse on duty by phone to discuss the case, provide all relevant details and arrange an appointment for assessment; urgent cases will be seen the same day.  Children will be assessed by the duty doctor, accompanied by a nurse to determine the care required. Please note the following:
• Patients diagnosed with cancer and in the age group 0 - 19 years, undergoing treatment.
• All patients admitted to PPCC ward must be accompanied by a Parent/Guardian.
• Eighty per cent of inpatient beds will be designated for pediatric cancer patients with up to 20 per cent available to non-cancer patients with palliative care needs.
• Under exceptional circumstances an adult patient with palliative care needs may be admitted to into a single occupancy room (Isolation room) for inpatient care.
• Priority for admission will be given for patients with severe symptoms or end of life stage.

Children may be admitted for:

• Pain and symptom management
• Patient requiring dressing change
• Antibiotic administration
• Clinical Observation
• Potential admission through Triage.
• Physiotherapy
• Psychological Intervention.
• Dietary consultation
• For coordination with community services involving the social worker  

Exclusion Criteria for Admission:

• Serious Medical condition requiring hospitalization.
• Significant deterioration in mobility indicating admission at PPCC and other tertiary care centers.
• Patients diagnosed with communicable diseases will not be admitted to the inpatient unit, but may be seen in the outpatient or chattai clinic. A parent or guardian with communicable diseases will not be permitted to stay on the ward at PPCC if their child is admitted.

Operational Timings:

• PPCC functions 24x7
• Ambulatory clinic timings are thrice a day Monday- Sunday.
• Pain and wound management services are provided on daily basis throughout the week.
• Rests of the services are provided throughout the week except Sundays.