Lemmen Jesse, Albertine Njie, Abdi Miyaada, Mohan Nilesh, Keitany Kibet, Eliasson-Hofvander Marie, Kaspers Gertjan, Njuguna Festus
Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Pediatr Blood Cancer. 2025 Apr;72(4):e31544. doi: 10.1002/pbc.31544. Epub 2025 Jan 11.
Pediatric brain tumors are understudied compared to other pediatric malignancies in low- and middle-income countries. Care delivery is inherently dependent on collaboration between multiple departments. This study aimed to present baseline data of pediatric neuro-oncology care in Western Kenya and illustrate barriers and facilitators of multidisciplinary care.
We performed a mixed-methods study using medical records and interviews. Children below age 19 years, managed for a brain tumor at the neurosurgery or pediatric oncology departments between 2015 and 2022, were included. Various cadres (consultants, residents, medical officers, clinical officers, nurses, counselors) and teams (neurosurgery, pediatric oncology, radio-oncology, radiology, pathology) involved in pediatric brain tumor care participated.
Seventy-nine brain tumor patients were identified. The most prevalent confirmed diagnosis was medulloblastoma (n = 21). Most patients underwent surgery (n = 60; 76%). Event-free survival rate at 2 years was 13%. Abandonment was the most common (n = 36; 46%) treatment failure. Multidisciplinary consultation occurred more frequently between 2020 and 2022 than between 2015 and 2019 (OR 2.7 [95% CI: 1.0-6.9; p = 0.04]). Barriers and potential facilitators of multidisciplinary management were resources, diagnostic and therapeutic flow, standards, knowledge, information comprehension, and work relationships. Themes interacted at a governmental, facility, and community level.
This baseline overview of pediatric neuro-oncology care in Western Kenya showed that survival of children with pediatric brain tumors was poor and treatment abandonment was common. Strengthening the capacity at different organizational levels will improve continuity of care and expand the knowledge to support holistic multidisciplinary care for children with brain tumors in Kenya.
与低收入和中等收入国家的其他儿科恶性肿瘤相比，儿科脑肿瘤的研究较少。医疗服务的提供本质上依赖于多个部门之间的协作。本研究旨在呈现肯尼亚西部儿科神经肿瘤护理的基线数据，并阐明多学科护理的障碍和促进因素。
我们采用了混合方法研究，使用医疗记录和访谈。纳入了2015年至2022年间在神经外科或儿科肿瘤科接受脑肿瘤治疗的19岁以下儿童。参与儿科脑肿瘤护理的各种人员（顾问、住院医师、医务人员、临床干事、护士、顾问）和团队（神经外科、儿科肿瘤学、放射肿瘤学、放射学、病理学）参与了研究。
共确定了79例脑肿瘤患者。最常见的确诊诊断是髓母细胞瘤（n = 21）。大多数患者接受了手术（n = 60；76%）。2年无事件生存率为13%。放弃治疗是最常见的（n = 36；46%）治疗失败原因。2020年至2022年间多学科会诊比2015年至2019年间更频繁（OR 2.7 [95% CI：1.0 - 6.9；p = 0.04]）。多学科管理的障碍和潜在促进因素包括资源、诊断和治疗流程、标准、知识、信息理解和工作关系。这些主题在政府、机构和社区层面相互作用。
肯尼亚西部儿科神经肿瘤护理的这一基线概述表明，儿科脑肿瘤患儿的生存率较低，治疗放弃情况很常见。加强不同组织层面的能力将改善护理的连续性，并扩大知识范围，以支持肯尼亚脑肿瘤患儿的整体多学科护理。
