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Pediatric Solid Tumor Care and Multidisciplinary Tumor Boards in Low- and Middle-Income Countries in Southeast Asia
Mohd Yusran Othman1,2, Sally Blair3,4, Shireen A Nah5
1Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore.
Insights
Pediatric multidisciplinary tumor boards (MDTBs) in Southeast Asia are hindered by a lack of trained pathologists and radiologists. Improving subspecialist availability is crucial for enhancing pediatric solid tumor care in the region.
Area of Science:
- Pediatric Oncology
- Global Health
- Cancer Care Delivery
Background:
- Pediatric solid tumors necessitate coordinated multidisciplinary specialist care.
- Low- and middle-income countries (LMICs) face challenges in establishing multidisciplinary tumor boards (MDTBs) due to limited expertise and resources.
- Pediatric solid tumor units (PSTUs) in Southeast Asia require assessment of their care practices and MDTB feasibility.
Purpose of the Study:
- To profile pediatric solid tumor care practices in Southeast Asian LMICs.
- To assess the availability of pediatric subspecialists and MDTBs in these regions.
- To understand perceptions of MDTBs among pediatric oncologists and surgeons.
Main Methods:
- Online surveys were used to determine the availability of specialty manpower and MDTBs in PSTUs.
- A subset of PSTUs with MDTBs had pediatric surgeons and oncologists complete Likert scale questionnaires.
- Statistical analysis identified associations between specialist availability and MDTB existence.
Main Results:
- Availability of pediatric oncologists (94.6%), surgeons (91.9%), and nurses (81.1%) was high; however, radiologists (54.1%) and pathologists (40.5%) were less common.
- The presence of pediatric-trained surgeons, radiologists, and pathologists was significantly linked to the existence of MDTBs.
- Respondents identified complex cases, inadequate radiology/pathology preparation, and the need for further investigations as key barriers to MDTBs.
Conclusions:
- The availability of pediatric-trained subspecialists is a critical prerequisite for establishing pediatric MDTBs in Southeast Asia.
- Shortages in pediatric pathologists and radiologists were identified as major limitations for MDTBs.
- Enhancing multidisciplinary subspecialty development is essential for advancing pediatric solid tumor care in the region.
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.
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