Analysis of management decisions and outcomes of a weekly multidisciplinary pediatric tumor board meeting in Uganda

George, Paul E.; Fahdil, Geriga; Luutu, Israel; Bulamu, Alfred; Sekabira, John; Kakembo, Nasser; Nabadda, Susan; Kalungi, Sam; Kambugu, Joyce

doi:10.2144/fsoa-2019-0070

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…[72][73][74][75] Establishing a multidisciplinary team discussion or tumor board is a cornerstone of building capacity for pediatric oncology care. [72][73][74][75] One of the key limitations identified by the panel was a paucity of evidence to address the selected questions. When evidence exists, it is frequently of low certainty.…”

Section: Discussionmentioning

confidence: 99%

“…11,71 In addition, a multidisciplinary childhood cancer team incorporating radiologists, pathologists, oncologists, radiation oncologists, and surgical specialists who discuss the case prior to any surgical intervention is essential to ensure high quality of care. [72][73][74][75] Establishing a multidisciplinary team discussion or tumor board is a cornerstone of building capacity for pediatric oncology care. [72][73][74][75] One of the key limitations identified by the panel was a paucity of evidence to address the selected questions.…”

Section: Discussionmentioning

confidence: 99%

“…In a limited‐resource setting, childhood tumor treatment is often effective only if the patient presents early; therefore, access to timely therapy is of paramount importance 11,71 . In addition, a multidisciplinary childhood cancer team incorporating radiologists, pathologists, oncologists, radiation oncologists, and surgical specialists who discuss the case prior to any surgical intervention is essential to ensure high quality of care 72–75 . Establishing a multidisciplinary team discussion or tumor board is a cornerstone of building capacity for pediatric oncology care 72–75 .…”

Section: Discussionmentioning

confidence: 99%

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Evidence‐based surgical guidelines for treating children with Wilms tumor in low‐resource settings

Abdelhafeez

Reljic

Kumar

et al. 2022

Pediatric Blood & Cancer

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Background Survival of Wilms tumor (WT) is > 90% in high‐resource settings but < 30% in low‐resource settings. Adapting a standardized surgical approach to WT is challenging in low‐resource settings, but a local control strategy is crucial to improving outcomes. Objective Provide resource‐sensitive recommendations for the surgical management of WT. Methods We performed a systematic review of PubMed and EMBASE through July 7, 2020, and used the GRADE approach to assess evidence and recommendations. Recommendations Initiation of treatment should be expedited, and surgery should be done in a high‐volume setting. Cross‐sectional imaging should be done to optimize preoperative planning. For patients with typical clinical features of WT, biopsy should not be done before chemotherapy, and neoadjuvant chemotherapy should precede surgical resection. Also, resection should include a large transperitoneal laparotomy, adequate lymph node sampling, and documentation of staging findings. For WT with tumor thrombus in the inferior vena cava, neoadjuvant chemotherapy should be given before en bloc resection of the tumor and thrombus and evaluation for viable tumor thrombus. For those with bilateral WT, neoadjuvant chemotherapy should be given for 6–12 weeks. Neither routine use of complex hilar control techniques during nephron‐sparing surgery nor nephron‐sparing resection for unilateral WT with a normal contralateral kidney is recommended. When indicated, postoperative radiotherapy should be administered within 14 days of surgery. Post‐chemotherapy pulmonary oligometastasis should be resected when feasible, if local protocols allow omission of whole‐lung irradiation in patients with nonanaplastic histology stage IV WT with pulmonary metastasis without evidence of extrapulmonary metastasis. Conclusion We provide evidence‐based recommendations for the surgical management of WT, considering the benefits/risks associated with limited‐resource settings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evidence‐based surgical guidelines for treating children with Wilms tumor in low‐resource settings

Abdelhafeez

Reljic

Kumar

et al. 2022

Pediatric Blood & Cancer

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“…Several other sub-Saharan African (SSA) countries have implemented TBMs both in person and, recently, online [19]. While most TBMs in SSA are general in nature, there is a trend towards site-specific and speciality-specific TBMs [19,20]. However, some cancer centres in LMICs lack the necessary resources to organise TBMs; this is especially true in sub-Saharan Africa where there is a lack of multidisciplinary support from oncology specialists, oncology surgeons, pathologists and other key personnel as well as a lack of protected time for clinicians to attend TBMs [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary approach to cancer care in Rwanda: the role of tumour board meetings

Niyibizi¹,

Muhizi²,

Rangira³

et al. 2023

ecancer

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Introduction: Cancer treatment is complex and necessitates a multidisciplinary approach. Tumour Board Meetings (TBMs) provide a multidisciplinary platform for health care providers to communicate about treatment plans for patients. TBMs improve patient care, treatment outcomes and, ultimately, patient satisfaction by facilitating information exchange and regular communication among all parties involved in a patient's treatment. This study describes the current status of case conference meetings in Rwanda including their structure, process and outcomes. Methods:The study included four hospitals providing cancer care in Rwanda. Data gathered included patients' diagnosis, number of attendance and pre-TBM treatment plan, as well as changes made during TBMs, including diagnostic and management plan changes.Results: From 128 meetings that took place at the time of the study, Rwanda Military Hospital hosted 45 (35%) meetings, King Faisal Hospital had 32 (25%), Butare University Teaching Hospital (CHUB) had 32 (25%) and Kigali University Teaching Hospital (CHUK) had 19 (15%). In all hospitals, General Surgery 69 (29%) was the leading speciality in presenting cases. The top three most presented disease site were head and neck 58 (24%), gastrointestinal 28 (16%) and cervix 28 (12%). Most (85% (202/239)) presented cases sought inputs from TBMs on management plan. On average, two oncologists, two general surgeons, one pathologist and one radiologist attended each meeting. Conclusion:TBMs in Rwanda are increasingly getting recognised by clinicians. To influence the quality of cancer care provided to Rwandans, it is crucial to build on this enthusiasm and enhance TBMs conduct and efficiency.

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“…Interestingly, while availability of each of these elements may vary between centers, this does not preclude delivery of effective curative treatment for pediatric tumors when available resources can be appropriately channeled 18,19 . This underscores the importance of the multidisciplinary tumor board (MDTB) as a critical element for advancing pediatric solid tumor care, and one that remains relevant even in LMICs [20][21][22] . However, organizing MDTBs can be an organizational burden and amounts to extra workload for the involved personnel 23,24 , especially in centers with already-limited resources.…”

Section: Abstract 1 Introductionmentioning

confidence: 99%

Profile of Pediatric Solid Tumor Care and Multidisciplinary Tumor Boards in Southeast Asia

Othman

Blair²,

Nah

et al. 2020

Preprint

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Background Pediatric solid tumors require coordinated multidisciplinary specialist care. However, expertise and resources to conduct multidisciplinary tumor board (MDTB) meetings are lacking in low-and middle-income countries (LMICs). We aimed to profile practices and perceptions on MDTBs among pediatric solid tumor units (PSTUs) in Southeast Asian LMIC countries. Methods Using online survey forms, availability of specialty manpower and MDTBs among PSTUs was first determined. From the subset of PSTUs with MDTBs, 1 pediatric surgeon and 1 pediatric oncologist from each center were queried using 5-point Likert scale questions adapted from published questionnaires. Results In 37/46 (80.4%) identified PSTUs, pediatric-trained oncologists, surgeons, radiologists, pathologists, radiation oncologists, nuclear medicine physicians and nurses were available in 94.6%, 91.9%, 54.1%, 40.5%, 29.7%, 13.5% and 81.1% of PSTUs, respectively. Availability of pediatric-trained surgeons, radiologists and pathologists were significantly associated with existence of MDTBs (p=0.037, 0.005, 0.022 respectively). Among 43/48 (89.6%) respondents from 24 PSTUs with MDTBs, 90.5% of oncologists reported >50% oncology-dedicated workload versus 22.7% of surgeons. Views on benefits and barriers did not significantly differ between both groups. Majority agreed MDTBs helped improve accuracy of treatment recommendations and team competence. Complex cases, insufficient radiology and pathology preparation, and need for supplementary investigations, were the top barriers. Conclusions Availability of pediatric-trained subspecialists was a significant prerequisite for pediatric MDTBs. Most PSTUs lacked pediatric-trained pathologists and radiologists. Correspondingly, gaps in radiographic and pathological diagnoses were the commonest limitations. Greater emphasis on holistic multidisciplinary subspecialty development is needed to advance pediatric solid tumor care in Southeast Asia.

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Analysis of management decisions and outcomes of a weekly multidisciplinary pediatric tumor board meeting in Uganda

Cited by 7 publications

References 25 publications

Evidence‐based surgical guidelines for treating children with Wilms tumor in low‐resource settings

Evidence‐based surgical guidelines for treating children with Wilms tumor in low‐resource settings

Multidisciplinary approach to cancer care in Rwanda: the role of tumour board meetings

Profile of Pediatric Solid Tumor Care and Multidisciplinary Tumor Boards in Southeast Asia

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