TY - JOUR
T1 - Exploring treatment decision-making at diagnosis for children with advanced cancer in low- and middle-income countries
AU - the CATALYST Advisory Group
AU - Salek, Marta
AU - Porter, Amy S.
AU - Maradiege, Essy
AU - Dolendo, Mae Concepcion J.
AU - Figueredo, Diego
AU - Geriga, Fadhil
AU - Gunasekera, Sanjeeva
AU - Kizyma, Roman
AU - Nguyen, Hoa Thi Kim
AU - Nzamu, Irene
AU - Raza, Muhammad Rafie
AU - Rustamova, Khilola
AU - Sari, Nur Melani
AU - Rodriguez-Galindo, Carlos
AU - Graetz, Dylan
AU - Bhakta, Nickhill
AU - Kaye, Erica C.
AU - Wise, Paul H.
AU - Hunleth, Jean M.
AU - Friedrich, Paola
AU - Force, Lisa
AU - Baker, Justin N.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/11
Y1 - 2024/11
N2 - 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.
AB - 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.
KW - Decision-making
KW - Global health
KW - Low- and middle-income countries
KW - Pediatric cancer
KW - Poor prognosis
UR - http://www.scopus.com/inward/record.url?scp=85208164292&partnerID=8YFLogxK
U2 - 10.1007/s00520-024-08951-z
DO - 10.1007/s00520-024-08951-z
M3 - Article
C2 - 39472335
AN - SCOPUS:85208164292
SN - 0941-4355
VL - 32
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 11
M1 - 753
ER -