Quality indicators for the care of children with CNS tumors: An international modified Delphi study

Licona S.; Hamid S.A.; Mutura E.; Ahmad A.; Bag A.; Bailey S.; Baticulon R.E.; Boop F.; Bouffet E.; Cahyanti D.; Chamdine O.; Chang K.T.E.; Das G.; Dewan M.C.; Diaz-Coronado R.; Foo J.C.; Giron V.; Lassaletta A.; Lucas J.T., Jr; Morales-La Madrid A.; Navarro-Martin del Campo R.M.; Omran N.; Osorio D.S.; Qaddoumi I.; Qureshi B.M.; Sabin N.D.; Sharafeldin H.; Sundar V.; Upadhyaya S.A.; Vinitsky A.; Wanyoike J.; Yasmeen N.; Moreira D.C. · Neuro-Oncology Advances (2026) · DOI: 10.1093/noajnl/vdag206

Resumen

Background: Pediatric central nervous system (CNS) tumors are the leading cause of cancer-related death among children and adolescents globally. Despite the complex and multidisciplinary care needed, there is limited evidence on standardized quality indicators (QIs) for pediatric neuro-oncology (PNO). Methods: A modified Delphi process was conducted to develop consensus-based QIs for PNO. Candidate indicators were identified through a systematic review of published literature. After expert screening, indicators were evaluated by a multidisciplinary panel through 2 rounds of Delphi surveys. Consensus was defined as ≥75% agreement. A subsequent consensus meeting and tiering process were conducted to categorize the selected indicators. Results: The systematic review identified 35 studies containing 124 relevant indicators; these were subsequently refined to 63 candidate indicators for evaluation in 2 Delphi surveys. Thirty-two experts from 5 specialties and 15 countries participated in the consensus process. A consensus was established that included that indicators would have the following 3 characteristics: reflect the continuum of PNO care, be continuous variables, and be feasible to measure across diverse resource settings. Through 2 rounds of Delphi surveys, a total of 48 indicators met the consensus threshold. Indicators were subsequently consolidated to 31, following discussion and merging of overlapping items. Final indicators were categorized into 2 sets: 19 core indicators and 12 extended indicators. Conclusions: By providing a framework for evaluating quality across the continuum of PNO care, these indicators can aid benchmarking and guide quality improvement interventions. Prospective validation and assessment of their impact on patient outcomes are still needed. © The Author(s) 2026. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

Instituciones: Universidad Peruana Cayetano Heredia