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Open Access 01-11-2024 | Pediatric Cancer | Research

Exploring treatment decision-making at diagnosis for children with advanced cancer in low- and middle-income countries

Authors: Marta Salek, Amy S. Porter, Essy Maradiege, Mae Concepcion J. Dolendo, Diego Figueredo, Fadhil Geriga, Sanjeeva Gunasekera, Roman Kizyma, Hoa Thi Kim Nguyen, Irene Nzamu, Muhammad Rafie Raza, Khilola Rustamova, Nur Melani Sari, Carlos Rodriguez-Galindo, Dylan Graetz, Nickhill Bhakta, Erica C. Kaye, the CATALYST Advisory Group

Published in: Supportive Care in Cancer | Issue 11/2024

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Abstract

Purpose

Global childhood cancer survival outcomes correlate with regional contextual factors, yet upfront treatment decision-making for children with advanced or poor prognosis cancer in low- and middle-income countries (LMICs) is not well understood. This study aimed to (1) characterize the landscape of contextual factors that shape physician decision-making at diagnosis for these children in LMICs and (2) describe physician rationales for if/when to offer treatment with non-curative intent, including how they define “poor prognosis” during treatment decision-making.

Methods

An international panel of pediatric oncologists practicing in LMICs participated in two focus groups structured for the collaborative generation of factors influencing treatment decision-making, including consideration of non-curative treatment pathways at diagnosis. Thematic analysis of qualitative data was conducted, followed by member checking.

Results

Eleven pediatric oncologists participated, representing all global regions defined by the World Health Organization. Participants identified a broad range of factors influencing decision-making across multiple levels, including the individual, hospital, health system, community, and country levels. All participants agreed that treatment with non-curative intent could be offered at diagnosis in certain contexts, and diverse definitions for poor prognosis were described.

Conclusions

Upfront treatment decision-making for children with advanced or poor prognosis cancer in LMICs is variable and challenging. Difficulties with decision-making in LMICs may be amplified by inconsistent definitions of poor prognosis and underrepresentation of the factors that influence treatment decision-making within existing decision-making frameworks or childhood cancer treatment guidelines. Future research should explore decision-making approaches, preferences, and challenges in depth from the perspectives of pediatric cancer patients, families, and multidisciplinary clinicians.
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Metadata
Title
Exploring treatment decision-making at diagnosis for children with advanced cancer in low- and middle-income countries
Authors
Marta Salek
Amy S. Porter
Essy Maradiege
Mae Concepcion J. Dolendo
Diego Figueredo
Fadhil Geriga
Sanjeeva Gunasekera
Roman Kizyma
Hoa Thi Kim Nguyen
Irene Nzamu
Muhammad Rafie Raza
Khilola Rustamova
Nur Melani Sari
Carlos Rodriguez-Galindo
Dylan Graetz
Nickhill Bhakta
Erica C. Kaye
the CATALYST Advisory Group
Publication date
01-11-2024
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 11/2024
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-024-08951-z

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