de Souza Fernanda Kelly Marques, de Campos Vieira Abib Simone, Ribeiro Rodrigo Chaves, de Campos Débora Rebollo, Gallo Lily Saldaña, De la Cruz Raul Ramirez, Shalkow-Klincovstein Jaime, Ponce-Cruz Jesús, Elnour Mohammed, Ngongola Amon, Kalota Seith, Bvulani Bruce, Houston Logan, Misal Riya, Forrest Heather, Sullivan Nadya, Alvarez Alyana, Naradasu Srikanth, Maru Aman, Gonzalez-Guzman Miriam L, Friedrich Paola, Abdelhafeez Abdelhafeez
Department of Pediatric Surgery, Pediatric Oncology Institute - GRAACC - Federal University of São Paulo, São Paulo, Brazil.
Department of Pediatric Surgery, Barretos Children's Cancer Hospital, São Paulo, Brazil.
Cancer Med. 2025 Aug;14(15):e71122. doi: 10.1002/cam4.71122.
The global incidence of childhood cancer is rising, with nearly 90% of cases occurring in low- and middle-income countries (LMICs), where mortality remains high due to limited access to quality pediatric surgical care. To address this, the International Society of Pediatric Surgical Oncology (IPSO) and St. Jude Children's Research Hospital developed the Pediatric Oncology Facility Integrated Local Evaluation Surgical Tool (PrOFILE-ST) to assess surgical capacity and quality in resource-limited settings.
PrOFILE-ST was developed in three stages: construction, content validation, and pilot testing. The tool was refined over three years through biweekly team meetings and expert feedback. Pilot testing took place at six institutions across five countries (Sudan, Zambia, Peru, Mexico, Brazil), collecting both quantitative and qualitative data on surgical practices. Data was analyzed using descriptive statistics, producing reports to guide quality improvement.
The final tool consists of 12 modules and 273 questions. Pilot testing revealed differences in surgical capacity between upper-middle-income countries (UMICs) and lower middle/low-income countries (LMICs/LICs). UMICs had better infrastructure, while LMICs/LICs excelled in surgical reporting and timeliness. Improvement priorities included the development of pediatric surgical oncology fellowships, standardization of operative reporting, systematic morbidity and mortality analysis, and establishment of real-time multidisciplinary team discussions.
PrOFILE-ST is an effective tool for assessing pediatric oncology surgery across diverse settings, highlighting strengths and areas for improvement. It can guide quality improvement efforts to address global disparities in childhood cancer outcomes.
全球儿童癌症发病率呈上升趋势,近90%的病例发生在低收入和中等收入国家(LMICs),由于获得优质儿科手术护理的机会有限,这些国家的死亡率仍然很高。为解决这一问题,国际小儿外科肿瘤学会(IPSO)和圣裘德儿童研究医院开发了儿科肿瘤设施综合本地评估手术工具(PrOFILE-ST),以评估资源有限环境下的手术能力和质量。
PrOFILE-ST分三个阶段开发:构建、内容验证和试点测试。该工具通过每两周一次的团队会议和专家反馈,历时三年进行完善。在五个国家(苏丹、赞比亚、秘鲁、墨西哥、巴西)的六个机构进行了试点测试,收集了有关手术实践的定量和定性数据。使用描述性统计方法对数据进行分析,生成报告以指导质量改进。
最终工具包括12个模块和273个问题。试点测试揭示了中高收入国家(UMICs)与中低收入/低收入国家(LMICs/LICs)在手术能力上的差异。UMICs拥有更好的基础设施,而LMICs/LICs在手术报告和及时性方面表现出色。改进重点包括发展儿科外科肿瘤学奖学金、规范手术报告、系统的发病率和死亡率分析以及建立实时多学科团队讨论。
PrOFILE-ST是一种有效的工具,可用于评估不同环境下的儿科肿瘤手术,突出优势和改进领域。它可以指导质量改进工作,以解决全球儿童癌症治疗结果的差异。