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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

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Abstract

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.

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Data availability

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Acknowledgements

We thank Dr. Angela McArthur for the scientific editing of this manuscript.

Author information

Author notes

  1. Drs. Jen Chun Foo, Vida Jawin, Daniel C. Moreira, and Revathi Rajagopal contributed equally to this work.

Authors and Affiliations

  1. Division of Hematology-Oncology, Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia

    Jen Chun Foo, Vida Jawin, Tsiao Yi Yap & Revathi Rajagopal

  2. Division of Neuro-Surgery, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia

    Nor Faizal Ahmad Bahuri & Dharmendra Ganesan

  3. Department of Pathology, University Malaya Medical Center, Kuala Lumpur, Malaysia

    Kein Seong Mun

  4. Department of Clinical Radiation Oncology, University Malaya Medical Center, Kuala Lumpur, Malaysia

    Jasmin Loh

  5. Department of Radiology, University Malaya Medical Center, Kuala Lumpur, Malaysia

    Raja Rizal Azman

  6. Department of Pediatric and Adolescent Clinical Hematology and Oncology, Perth Children’s Hospital, Nedlands, Australia

    Nicholas G. Gottardo

  7. Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Ibrahim Qaddoumi & Daniel C. Moreira

Authors
  1. Jen Chun Foo
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Contributions

Revathi Rajagopal, Tsiao Yi Yap, Jasmin Loh, Nicholas G. Gottardo, Daniel C Moreira, and Ibrahim Qaddoumi designed the study. Jen Chun Foo and Vida Jawin collected the data. Nor Faizal Ahmad Bahuri, Dharmendra Ganesan, Kein Seong Mun, and Jen Chun Foo coordinated the web-based cross-sectional survey. Revathi Rajagopal and Daniel C Moreira analyzed the data. Jen Chun, Vida Jawin, Daniel Moreira, and Revathi Rajagopal drafted the manuscript. All authors reviewed and revised the manuscript.

Corresponding author

Correspondence to Revathi Rajagopal.

Ethics declarations

Ethics approval

Study approval was obtained from the University Malaya Medical Center Medical Research Ethics Committee for patient data collection (MREC ID: 201914-6968). The UMMC Ethics Committee waived the need for written informed consent from patients and families.

Conflict of interest

The authors have no conflicts of interest to declare.

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This report is from a Global Alliance Pediatric Neuro-Oncology quality improvement project conducted at the University Malaya Medical Center, Kuala Lumpur, Malaysia. Clinicians from various departments and centers participated in this study.

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Foo, J.C., Jawin, V., Yap, T.Y. et al. 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. Childs Nerv Syst 37, 1573–1580 (2021). https://doi.org/10.1007/s00381-021-05080-4

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