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

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


JournalJCO Global Oncology
Publication date – Sep – 2020
Authors – Mohd Yusran Othman, MBBS, MPaedSurg, Sally Blair, MD, MPH, Shireen A. Nah, MBBS, MS, Hany Ariffin, MBBS, MPaed, PhD, Chatchawin Assanasen, MD, Shui Yen Soh, MBBS, MRCPCH, Anette S. Jacobsen, MBBCh, FAMS, Catherine Lam, MD, MPH and Amos H. P. Loh, MBBS, FAMS
KeywordsLow-and middle-income countries, Multidisciplinary Tumor Boards, Pediatric Solid Tumors, Southeast Asia
Open access – Yes
SpecialityOther, Paediatric surgery, Surgical oncology
World region South-eastern Asia

Language – English
Submitted to the One Surgery Index on October 30, 2020 at 7:00 pm
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.

OSI Number – 20707
PMID – 32886560

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