Pdoc-07 the Clinicopathological Profile and Value of Multidisciplinary Management of Pediatric Brain Tumors in a Low-Income Setting

Abstract OBJECTIVE The management of paediatric brain tumours in low-income countries is challenging, and survival rates are low, making multi-disciplinary teams (MDT) inevitable in quality management. In Uganda, paediatric neuro-oncology services are in their infancy. This study evaluated the management of paediatric brain tumours at the Uganda Cancer Institute (UCI) to assess the contributions of MDT management in improving patient care and outcomes. METHODS A retrospective records review of paediatric brain tumours at the UCI between 2017 and 2021 was conducted. Patient and tumour characteristics, as well as MDT management, were sourced. A survey among MDT members was conducted to explore their perspectives. RESULTS Thirty-five paediatric brain tumour cases were treated at UCI, with a median age of 8.0 years (IQR 4.0–11.0) and a median duration of symptoms of six months (IQR 3.0-8.5). The majority (25.7%, n=9) were craniopharyngiomas, 14.3% (5/35) were astrocytomas, 11.4% (4/35) were medulloblastomas, and 8.6% (3/35) each were ependymomas and pineoblastomas. Overall, 22 (62.9%) of the cases were discussed on the MDT. The number of cases discussed in the MDT increased over the five years: 0/3 (0.0%) in 2017, 3/5 (60.0%) in 2018, 2/4 (50.0%) in 2019, 6/9 (66.7%) in 2020, and 11/14 (78.6%) in 2021. The proportion of multidisciplinary management decisions implemented also increased: 0% in 2018, 50% in 2019, 83.3% in 2020, and 81.8% in 2021. The majority of patients (12/15, 80.0%) for whom MDT recommendations were implemented were alive. Lack of neurosurgical resources (46.7%), imaging (46.6%), diversity of MDT roles (26.7%), access to radiotherapy (20.0%), and pathology (20.0%) were recognized as major impediments to paediatric neuro-oncology management. CONCLUSIONS Implementing multidisciplinary management decisions benefited children with brain tumours and decreased abandonment and patient loss to follow-up at the Uganda Cancer Institute. Greater emphasis should be placed on increasing resources and actionable treatment recommendations.