Building the ecosystem for pediatric neuro‐oncology care in Pakistan: Results of a 7‐year long twinning program between Canada and Pakistan

Abstract

Background: Low-and middle-income countries sustain the majority of pediatric cancer burden, with significantly poorer survival rates compared to high-income countries.Collaboration between institutions in low-and middle-income countries and highincome countries is one of the ways to improve cancer outcomes.Methods: Patient characteristics and effects of a pediatric neuro-oncology twinning program between the Hospital for Sick Children in Toronto, Canada and several hospitals in Karachi, Pakistan over 7 years are described in this article.Results: A total of 460 patients were included in the study. The most common primary central nervous system tumors were low-grade gliomas (26.7%), followed by medulloblastomas (18%), high-grade gliomas (15%), ependymomas (11%), and craniopharyngiomas (11.7%). Changes to the proposed management plans were made in consultation with expert physicians from the Hospital for Sick Children in Toronto, Canada. On average, 24% of the discussed cases required a change in the original management plan over the course of the twinning program. However, a decreasing trend in change in management plans was observed, from 36% during the first 3.5 years to 16% in the last 3 years. This program also led to the launch of a national pediatric neuro-oncology telemedicine program in Pakistan.

How Can Genomic Innovations in Pediatric Brain Tumors Transform Outcomes in Low- and Middle-Income Countries?

“…Where MDTs in the LMIC setting are grappling with the setting of priorities and the interpretation of diagnostic information, the development of these relationships can provide crucial assistance as LMIC teams develop the capacity to manage those processes. 41,42 Compassionate use programs. Although some targeted therapies have many advantages that would benefit patients in LMICs, access to these medications is a major issue and costs are prohibitive for patients and families.…”

“…Where MDTs in the LMIC setting are grappling with the setting of priorities and the interpretation of diagnostic information, the development of these relationships can provide crucial assistance as LMIC teams develop the capacity to manage those processes. 41 , 42 …”

Impact of treatment and clinical characteristics on the survival of children with medulloblastoma in Mexico

“…Implementing twinning programs, which have shown success in improving survival rates in low and middle-income countries, could also be a valuable strategy to consider ( 8 , 41 ).…”

Capacity building for pediatric neuro-oncology in Pakistan- a project by my child matters program of Foundation S

“…Moreover, fostering collaboration among healthcare providers in these disciplines is crucial to deliver comprehensive multidisciplinary care, guided by locally validated protocols. Central to our approach is the emphasis on the implementation of tumor boards in all cancer hospitals in Pakistan, in alignment with our overarching goal of enhancing pediatric neuro-oncology care in LMICs ( 10 , 16 ).…”

“…The program signifies a dedicated effort to improve the overall quality of care through the sharing of expertise and resources between these two institutions. The program’s achievements became evident through the adoption of refined and individualized management strategies, increased referrals to tertiary healthcare facilities, and the improved diagnostic facilities within the Pakistani healthcare landscape ( 10 ). Building upon the success of the SickKids collaboration, the Aga Khan University Hospital (AKUH) embarked on a mission to expand pediatric neuro-oncological care in Pakistan.…”