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Pediatric Neurosurgical Capacity for the Care of Children With CNS Tumors Worldwide: A Cross-Sectional Assessment
Jordan T Roach1,2,3, Ibrahim Qaddoumi4, Ronnie E Baticulon5
1College of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Insights
Pediatric neurosurgical capacity varies globally, with lower-income countries having fewer resources for treating childhood brain tumors. Enhancing infrastructure and multidisciplinary support is crucial for improving outcomes in these regions.
Area of Science:
- Pediatric neurosurgery
- Global health equity
- Childhood cancer research
Background:
- Childhood cancer, including pediatric central nervous system (CNS) tumors, represents a significant global health burden.
- Low-grade glioma is recognized as an index cancer by the World Health Organization Global Initiative for Childhood Cancer, highlighting the need to address treatment inequities.
- Understanding pediatric neurosurgical capacity is vital for improving outcomes for children with CNS tumors.
Purpose of the Study:
- To evaluate the global pediatric neurosurgical capacity and identify disparities in resources.
- To assess the availability of infrastructure, personnel, and multidisciplinary care for pediatric neurosurgery worldwide.
- To inform interventions aimed at improving care for children with low-grade glioma and other CNS tumors.
Main Methods:
- A cross-sectional online survey was distributed to members of the International Society of Pediatric Neurosurgery.
- The survey assessed pediatric neurosurgical practice and capacity across 61 countries, covering patient volume, infrastructure, scope of practice, and multidisciplinary care.
- Responses were analyzed based on World Bank country income groups (high-income, upper-middle-income, lower-middle-income, low-income).
Main Results:
- Responses from 196 individuals across all WHO regions were included, with varying representation from different income-level countries.
- While basic neurosurgical resources were generally available, quantitative scoring revealed fewer infrastructure and service resources in lower-income countries compared to high-income countries.
- Pediatric central nervous system tumor case volume and distribution did not significantly differ across country income groups.
Conclusions:
- Significant variability exists in pediatric neurosurgical capacity globally, strongly correlated with country income levels.
- Pediatric neurosurgeons in lower-middle-income countries (LMICs) require enhanced neurosurgical instrumentation and support for multidisciplinary brain tumor programs.
- Increased investment in childhood cancer research and global collaboration is essential to address disparities in care for pediatric CNS tumors.
Purpose:
Efforts to address inequities in the treatment of pediatric CNS tumors and the burden of childhood cancer globally have prompted the designation of low-grade glioma as one of six index cancers for the World Health Organization Global Initiative for Childhood Cancer. Understanding the importance of neurosurgical interventions and evaluating pediatric neurosurgical capacity may identify critical interventions to improve outcomes for children with low-grade glioma and other CNS tumors.
Methods:
An online, cross-sectional survey assessing pediatric neurosurgical practice and capacity was distributed to members of the International Society of Pediatric Neurosurgery. The survey included 36 items covering domains including patient volume, available infrastructure, scope of practice, case distribution, and multidisciplinary care.
Results:
Responses from 196 individuals from 61 countries, spanning all WHO regions, were included. Ninety-six (49.0%) were from high-income countries, 57 (29.1%) were from upper-middle-income countries, 42 (21.4%) were from lower-middle-income countries (LMICs), and 1 was (0.5%) from a low-income country. Most respondents had a catchment population of ≥ 1 million and indicated the availability of basic neurosurgical resources such as a dedicated neurosurgical operating theater and surgical microscope. The presence of a neurosurgical intensive care unit, inpatient rehabilitation services, and infection monitoring showed similar availability across country groups. Quantitative scoring of 13 infrastructure and service items established that fewer resources were available in low-income countries/LMICs and upper-middle-income countries compared with high-income countries. The volume of pediatric CNS tumor cases and case distribution did not vary according to World Bank country groups.
Conclusion:
This study provides a comprehensive evaluation of pediatric neurosurgical capacity across the globe, establishing variability of resources on the basis of the country income level. Our findings suggest that pediatric neurosurgeons in LMICs may benefit from key neurosurgical instrumentation and increased support for multidisciplinary brain tumor programs and childhood cancer research efforts.
