Othman Mohd Yusran, Blair Sally, Nah Shireen A, Ariffin Hany, Assanasen Chatchawin, Soh Shui Yen, Jacobsen Anette S, Lam Catherine, Loh Amos H P
Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore.
Department of Pediatric Surgery, Hospital Tunku Azizah (Women's and Children's Hospital), Kuala Lumpur, Malaysia.
JCO Glob Oncol. 2020 Aug;6:1328-1345. doi: 10.1200/GO.20.00284.
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.
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.
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 ( = .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.
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.
儿童实体瘤需要多学科专家的协同护理。然而，低收入和中等收入国家（LMICs）缺乏开展多学科肿瘤委员会（MDTBs）的专业知识和资源。我们旨在描述东南亚低收入和中等收入国家儿童实体瘤治疗单位（PSTUs）的儿童实体瘤护理情况、实践以及对多学科肿瘤委员会的看法。
通过在线调查，首先确定儿童实体瘤治疗单位中专科人力和多学科肿瘤委员会的情况。从有多学科肿瘤委员会的儿童实体瘤治疗单位子集中，使用从已发表问卷改编的5点李克特量表问题，对每个中心的一名儿科外科医生和一名儿科肿瘤学家进行询问。
在46个已确定的儿童实体瘤治疗单位中的37个（80.4%），接受过儿科培训的专科医生情况如下：肿瘤学家，94.6%；外科医生，91.9%；放射科医生，54.1%；病理科医生，40.5%；放射肿瘤学家，29.7%；核医学医生，13.5%；护士，81.1%。接受过儿科培训的外科医生、放射科医生和病理科医生的配备情况与多学科肿瘤委员会的存在显著相关（分别为P = 0.037、0.005和0.022）。在来自24个有多学科肿瘤委员会的儿童实体瘤治疗单位的48名受访者中的43名（89.6%）中，90.5%的肿瘤学家报告其肿瘤专科工作量超过50%，而外科医生的这一比例为22.7%。肿瘤学家和外科医生对益处和障碍的看法没有显著差异。大多数人认为多学科肿瘤委员会有助于提高治疗建议的准确性和团队能力。复杂病例、放射学和病理学准备不足以及需要补充检查是主要障碍。
东南亚儿童实体瘤护理的这一首次已知概况发现，接受过儿科培训的亚专科医生的配备是该地区儿童多学科肿瘤委员会的重要前提条件。大多数儿童实体瘤治疗单位缺乏接受过儿科培训的病理科医生和放射科医生。相应地，影像学和病理学诊断方面的差距是多学科肿瘤委员会最常见的限制因素。需要更加强调整体多学科亚专科发展，以推进东南亚儿童实体瘤护理。
