Impact of dedicated pediatric neuro‐oncological services in a developing country: A single‐institution, Pakistani experience

Abstract

Introduction Brain tumors are the most common solid neoplasms and the second most common malignancy in the pediatric age group. Due to the complexity of their management, pediatric central nervous system (CNS) tumors are not a priority in low‐ and middle‐income countries (LMICs). Methods In an attempt to improve the survival rate and overall care, we introduced a dedicated pediatric neuro‐oncology service in our institute and evaluated its impact by dividing the pre‐ and post‐era into two cohorts and comparing them: 1998–2013 (16 years: cohort A) and 2014–2019 (6 years: cohort B, after the start of dedicated neuro‐oncology services). Results We observed that after the implementation of a proper neuro‐oncology service, the proportion of patients treated with curative intent increased, and survival improved in cohort B. The patient volume also increased from 15.5 per year in cohort A to 44.8 per year in cohort B. The percentage of children given radiation therapy also increased significantly, while the proportion of children treated with chemotherapy remained stable. Conclusion A dedicated multidisciplinary team trained and knowledgeable in the specialty of pediatric neuro‐oncology can enhance and improve outcomes, and supportive care and help can provide good quality of life to children and their families with brain neoplasms.

Resources for the practice of pediatric neuro-oncology in Mexico: a cross-sectional evaluation

“…Ideally, hospitals that treat children with CNS tumors should have all the necessary resources to carry out comprehensive diagnosis and treatment, including not only cancer-directed therapy, but also supportive and palliative care. Furthermore, these resources need to be integrated into functioning, efficient pediatric neuro-oncology services (18). Our data suggest that, for many institutions, key elements of care are lacking.…”

A retrospective analysis of practical benefits and caveats of the new WHO 2021 central nervous system tumor classification scheme in low‐resource settings: “A perspective from low‐ and middle‐income countries”

“…Among the most challenging issues related to the new classification is the complexity introduced by recent molecular discoveries. The increasing number of molecular studies and the desire to rapidly integrate new discoveries into the existing classification have led to uncertainties about diagnostic/grading criteria, unorthodox use of terminology, 2 the creation of new entities with limited evidence, 3,4 the limited clinical utility of some developments, 5 increased costs and limited availability, [6][7][8] the need for expertise, [9][10][11] and frequent demands for updates. 12 Despite these challenges, CNS WHO 2021 provides a critical framework that should provide guidance for patient management and the comparison of outcomes throughout the world, at least in theory.…”

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“…Ideally, hospitals that treat children with CNS tumors should have all the necessary resources to carry out comprehensive diagnosis and treatment, including not only cancer-directed therapy, but also supportive and palliative care. Furthermore, these resources need to be integrated into functioning, efficient pediatric neuro-oncology services (18). Our data suggest that, for many institutions, key elements of care are lacking.…”