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.

FIG 1

Distribution of the multidisciplinary workforce caring for pediatric solid tumors in Southeast Asia. (A) Geographical locations of pediatric care units in Southeast Asia with indication of level of expertise available for seven key roles (oncologists, surgeons, radiologists, pathologists, radiation oncologists, nuclear medicine physicians, and nurses) in each center. Number of centers per country are indicated in parentheses, and percentage of centers per country with multidisciplinary tumor boards (MDTBs) are indicated by color scale. (B) Total number of personnel and proportion of corresponding levels of expertise for seven key roles for nine Southeast Asian countries, ranked by size of national population aged ≤ 19 years. GNI, gross national income; Pop., population.

FIG 2

Profile of pediatric multidisciplinary tumor boards (MDTBs) in Southeast Asia. (A) Reported average attendance of seven key roles (oncologists, surgeons, radiologists, pathologists, radiation oncologists [Rad. oncol.], nuclear medicine physicians [Nucl. med.], and nurses) at MDTBs and reported frequency of MDTB meetings in 24 centers in six Southeast Asian countries. (B) Availability of MDTB resources as reported by oncologists and surgeons. PSTU, pediatric solid tumor unit.

FIG 3

Views on pediatric multidisciplinary tumor boards (MDTBs). Views of oncologists and surgeons from six Southeast Asian countries toward (A) factors that make for effective MDTBs, (B) benefits experienced by MDTBs, (C) patients being discussed at MDTBs, and (D) barriers faced by MDTBs in their centers.

FIG A1

Profile of respondents (21 pediatric oncologists and 22 pediatric surgeons) and their (A) level of training, (B) proportion of workload dedicated to oncology patients, and (C) years in practice.