Pediatric Solid Tumor Care and Multidisciplinary Tumor Boards in Low- and Middle-Income Countries in Southeast Asia

Abstract

PURPOSE Pediatric solid tumors require coordinated multidisciplinary specialist care. However, expertise and resources to conduct multidisciplinary tumor boards (MDTBs) are lacking in low- and middle-income countries (LMICs). We aimed to profile the landscape of pediatric solid tumor care and practices and perceptions on MDTBs among pediatric solid tumor units (PSTUs) in Southeast Asian LMICs. METHODS Using online surveys, availability of specialty manpower and MDTBs among PSTUs was first determined. From the subset of PSTUs with MDTBs, one pediatric surgeon and one pediatric oncologist from each center were queried using 5-point Likert scale questions adapted from published questionnaires. RESULTS In 37 (80.4%) of 46 identified PSTUs, availability of pediatric-trained specialists was as follows: oncologists, 94.6%; surgeons, 91.9%; radiologists, 54.1%; pathologists, 40.5%; radiation oncologists, 29.7%; nuclear medicine physicians, 13.5%; and nurses, 81.1%. Availability of pediatric-trained surgeons, radiologists, and pathologists was significantly associated with the existence of MDTBs ( P = .037, .005, and .022, respectively). Among 43 (89.6%) of 48 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 oncologists and surgeons. The majority agreed that MDTBs helped to improve accuracy of treatment recommendations and team competence. Complex cases, insufficient radiology and pathology preparation, and need for supplementary investigations were the top barriers. CONCLUSION This first known profile of pediatric solid tumor care in Southeast Asia found that availability of pediatric-trained subspecialists was a significant prerequisite for pediatric MDTBs in this region. Most PSTUs lacked pediatric-trained pathologists and radiologists. Correspondingly, gaps in radiographic and pathologic diagnoses were the most common limitations for MDTBs. Greater emphasis on holistic multidisciplinary subspecialty development is needed to advance pediatric solid tumor care in Southeast Asia.

Global Neuroblastoma Network: An international multidisciplinary neuroblastoma tumor board for resource‐limited countries

“…For example, due to the demand for help with palliative care, GNN sponsored a series of five education sessions on these topics (Table S1), with broad application to all of pediatric cancer. The participants also affirmed that such tumor boards would be useful for other pediatric malignancies, as suggested in another recent survey 21 . A recent study of telemedicine discussions for the highly specialized care required for retinoblastoma showed improved outcomes with this approach, especially when coupled with centralized specialty care for patients from regional LMIC 22 .…”

“…The participants also affirmed that such tumor boards would be useful for other pediatric malignancies, as suggested in another recent survey. 21 A recent study of telemedicine discussions for the highly specialized care required for retinoblastoma showed improved outcomes with this approach, especially when coupled with centralized specialty care for patients from regional LMIC. 22 These efforts must be coupled with resource The economic and other limitations noted by GNN participants again show that without further infrastructure development, the cure rate for high-risk neuroblastoma is unlikely to reach 50%, only recently achieved in HIC.…”

Impact of treatment refusal and abandonment on survival outcomes in pediatric osteosarcoma in Southeast Asia: A multicenter study

“…Management of pediatric solid tumors requires complex multidisciplinary care and advanced supportive care. 1 Osteosarcoma exhibits a poor prognosis in metastatic disease at presentation and surgeryrelated deformities and disabilities. In the developed world, treatment outcomes in osteosarcoma are promising and have been improving over time.…”

“…The management of pediatric osteosarcoma requires a coordinated multidisciplinary care with competent resources 1 . However, the advanced infrastructure and human resources, which are needed to operate the system, are limited in low‐ and middle‐income countries (LMC).…”

Building a Foundation for the Care of Children with Cancer in Rural North India

“…We are preparing to amalgamate digital health systems and telemedicine into routine care, which has been shown to be valuable in resource-poor settings, bringing in expert help through virtual tumor boards and delivering outreach services without physical presence. 13,14 The National Cancer Grid tumor board run out of Tata Memorial and Max Hospitals, Mumbai, India, illustrates such an initiative (https:// tmc.gov.in/ncg/index.php/activities-ncg/vrtual-tumorboard). Tapping into a larger Global Cancer Alliance 2 would be of major strategic and logistic advantage, particularly in pandemic and post-pandemic eras and help in complex clinical decision-making.…”