Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Towards precision palliative care: International Delphi consensus on optimal timing of palliative care communication for adolescents and young adults with cancer (146557)

Ursula M Sansom-Daly 1 2 3 , Madeleine L Juhrmann 1 2 , Holly E Evans 1 2 , Lori Wiener 4 , Anne-Sophie Darlington 5 , Hanneke Poort 6 , Abby R Rosenberg 6 7 8 , Meaghann S Weaver 9 , Fiona Schulte 10 , Antoinette Anazodo 2 , Anthony R Herbert 11 12 , Jennifer W Mack 13 , Louise Sue 14 , Toni Lindsay 15 , Nancy Briggs 16 , Elin Irestorm 1 17 , Maria Cable 18 , Amanda Fernando 19 , Richard J Cohn 1 2 , Claire E Wakefield 1 20
  1. Behavioural Sciences Unit, Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
  2. Minderoo Children's Comprehensive Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
  3. Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospitals, Randwick, NSW, Australia
  4. Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, United States
  5. School of Health Sciences, University of Southampton, Highfield, Southampton, UK
  6. Department of Supportive Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
  7. Department of Pediatrics, Boston Children’s Hospital, Boston, USA
  8. Department of Pediatrics Divisions of Palliative Care & Pediatric Hematology/Oncology, Harvard Medical School, Massachusetts, USA
  9. St Jude Children's Research Hospital, Memphis, Tennessee, USA
  10. Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  11. Queensland Children's Hospital, Brisbane, Queensland, Australia
  12. Centre for Children's Research, Queensland University of Technology, Brisbane, Queensland, Australia
  13. Population Sciences fo Pediatric Hematology/Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
  14. Adolescent and Young Adult Cancer Services Team, Te Whatu Ora/Health NZ, Christchurch, Waitaha, New Zealand
  15. Chris O'Brien Lifehouse Cancer Centre, Camperdown, NSW, Australia
  16. Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, NSW, Australia
  17. Faculty of Medicine, Department of Paediatrics, Lund University, Lund, Sweden
  18. Nursing and Midwifery in the Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
  19. Palliative Care Service, Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW , Australia
  20. Division of Quality of Life and Pediatric Palliative Care, Department of Pediatrics, Stanford University and Stanford Medicine Children's Health, Palo Alto, California, USA

Aims

Adolescents and young adults (AYAs) aged 15-39 with cancer have distinct palliative care needs, yet there is limited guidance on the optimal timing of palliative and end-of-life communication across the care trajectory. To improve the integration of timely palliative care for AYAs, this study aimed to establish international consensus on 1) when key palliative care discussions should ideally occur, and 2) how this differs according to patient prognosis and the communication topic being introduced.

Methods

A three-round Delphi study was conducted with multidisciplinary health-professionals experienced in AYA oncology. Participants rated the appropriateness of introducing four communication topics-prognosis and goals of care, emotional/existential issues, quality of life, and end-of-life–related medical care across prognostic categories and disease trajectory timepoints. Consensus was defined as ≥80% agreement.

Results

A total of 234 participants completed the Delphi first-round from 7 countries (Australia, New Zealand, USA, UK, Belgium, Spain and India), with 77 completing all rounds. Participating health-professionals from >5 disciplines (18% oncologists) worked across paediatric (43%), AYA (23%), and adult (24%) healthcare settings. A consistent staged pattern of communication emerged. Emotional/existential discussions were considered appropriate early in care, reaching consensus even when estimated survival exceeded 75% (89.6% consensus) and during active cancer treatment (88.2%). Prognosis/goals-of-care discussions were considered appropriate once estimated survival declined to 50–75% (93.5%), whereas end-of-life medical discussions were considered appropriate later in the disease trajectory, reaching consensus only at lower survival probabilities (25–50%; 92.2%) and by second relapse (93.4%).

Conclusions

Rather than a single event, palliative and end-of-life communication with AYAs can be conceptualised as a staged process across the cancer trajectory – with vital opportunities to integrate these discussions at key timepoints alongside active treatment and clinical trial participation. Our findings provide a consensus-based framework to support more person-centred, precision palliative care communication along the cancer care trajectory.