Conduct of neuro-oncology multidisciplinary team meetings and closing the "gaps" in the clinical management of childhood central nervous system tumors in a middle-income country.

Autor: Foo JC; Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia., Jawin V; Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia., Yap TY; Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia., Ahmad Bahuri NF; Division of Neuro-Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia., Ganesan D; Division of Neuro-Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia., Mun KS; Department of Pathology, University Malaya Medical Center, Kuala Lumpur, Malaysia., Loh J; Department of Clinical Radiation Oncology, University Malaya Medical Center, Kuala Lumpur, Malaysia., Azman RR; Department of Radiology, University Malaya Medical Center, Kuala Lumpur, Malaysia., Gottardo NG; Department of Pediatric and Adolescent Clinical Hematology and Oncology, Perth Children's Hospital, Nedlands, Australia., Qaddoumi I; Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA., Moreira DC; Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA., Rajagopal R; Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia. rgrevathi19@gmail.com.
Jazyk: angličtina
Zdroj: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery [Childs Nerv Syst] 2021 May; Vol. 37 (5), pp. 1573-1580. Date of Electronic Publication: 2021 Feb 12.
DOI: 10.1007/s00381-021-05080-4
Abstrakt: Purpose: Multidisciplinary team meetings (MDTMs) are essential in the clinical management of pediatric central nervous system (CNS) tumors. Evaluations of the impact of MDTMs on childhood CNS tumors and clinicians' perspectives on their effectiveness are scarce.
Methods: We retrospectively reviewed the clinical data of pediatric patients (aged <18 years) with CNS tumors diagnosed and treated in the Pediatric Hematology-Oncology Division at the University Malaya Medical Center from 2008 to 2019. We also conducted a web-based survey of the core members of the multidisciplinary team to evaluate the impact of the MDTMs.
Results: During the pre-MDTM era (2008-2012), 29 CNS tumors were diagnosed and treated, and during the MDTM era (2014-2019), 49 CNS tumors were diagnosed and treated. The interval for histologic diagnosis was significantly shorter during the MDTM era (p=0.04), but the interval from diagnosis to chemotherapy or radiotherapy and the 5-year overall survival of the 78 patients did not improve (62.1% ± 9.0% vs. 68.8% ± 9.1%; p=0.184). However, the 5-year overall survival of patients with medulloblastoma or rare tumors significantly improved in the MDTM era (p=0.01). Key factors that contributed to delayed treatment and poor outcomes were postoperative complications, the facility's lack of infrastructure, poor parental education about early treatment, cultural beliefs in alternative medicine, and infection during chemotherapy. Eighteen clinicians responded to the survey; they felt that the MDTMs were beneficial in decision-making and enhanced the continuity of coordinated care.
Conclusion: MDTMs significantly reduced the diagnostic interval and improved the overall outcomes. However, delayed treatment remains a major challenge that requires further attention.
Databáze: MEDLINE
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