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

Salek M.; Porter A.S.; Maradiege E.; Dolendo M.C.J.; Figueredo D.; Geriga F.; Gunasekera S.; Kizyma R.; Nguyen H.T.K.; Nzamu I.; Raza M.R.; Rustamova K.; Sari N.M.; Rodriguez-Galindo C.; Graetz D.; Bhakta N.; Kaye E.C.; Wise P.H.; Hunleth J.M.; Friedrich P.; Force L.; Baker J.N. · Supportive Care in Cancer (2024) · DOI: 10.1007/s00520-024-08951-z

Resumen

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. © The Author(s) 2024.