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Published on: January 9, 2019
A capability-stratified framework for high-grade glioma care: A domain-level analysis across the Asia-Pacific Region
Adrian J Praeger1, Lily Davies2, Katharine J Drummond3
1Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; MoLBi Research Group, Monash University, Melbourne, Victoria, Australia.
Background:
International guidelines for high-grade glioma are based largely on evidence from well-resourced health systems and assume access to advanced imaging, molecular diagnostics, subspecialised neurosurgery, and coordinated adjuvant therapy. These resources are not uniformly available across the Asia-Pacific region, limiting the applicability of guideline recommendations in many settings.
Methods:
We performed a structured domain-level analysis comprising three components: review of contemporary international glioma guidelines to identify the infrastructure and workforce required for their implementation; synthesis of published evidence on neuro-oncology capacity across the Asia Pacific region; and iterative development of a capability-stratified framework by the multidisciplinary author group. Institutional capability was classified across four cumulative levels and tumour complexity across three categories.
Results:
Four interdependent domains were identified: diagnostic, operative, pathology and molecular, and oncology and supportive care. Marked regional differences were evident across all four domains. Consultant neurosurgeon density ranged from no neurosurgical workforce in several countries to 7.95 per 100,000 population in Japan, with additional disparities in radiotherapy, molecular diagnostics and financial access to treatment. These limitations frequently occurred together rather than in isolation. The resulting four-level framework links tumour complexity to the combined resources available within an institution and provides a basis for adapting care to local circumstances.
Conclusion:
International standards for high-grade glioma cannot be implemented uniformly across health systems with widely differing resources. The proposed framework links tumour complexity to institutional capability and provides a practical basis for adapting guideline-based care, prioritising service development and identifying areas where regional referral or collaboration may be required.