Lmic-05. The Role of Centralization in Pediatric Neuro-Oncology: Evidence From a Developing Country

BACKGROUND Several studies from developed countries showed that centralization of pediatric cancer care is associated with survival benefits. The role of centralization might be crucial in pediatric neuro-oncology where multidisciplinary approach is essential. The aim of this study is to evaluate the impact of centralization in neuro-oncology in a developing country. METHODS In 2019, the consolidation of three pre-existing pediatric oncology units in Armenia resulted in the centralization of pediatric cancer care. After 2019 all patients undergo chemotherapy and follow up at the Pediatric Cancer and Blood Disorders Center of Armenia. This analysis compares demographic data, tumor characteristics and management of 54 patients diagnosed before centralization (2009-2018) and 66 patients diagnosed after centralization (2019-2023). RESULTS After centralization the incidence of recorded newly diagnosed CNS tumors in Armenia has dramatically increased (2.4 times). Six cases of CNS tumors diagnosed before 2019 were first registered after centralization. Assessment for metastatic status in embryonal tumors after centralization improved (20% vs 93.75%, p=0.0001). In addition, increased molecular testing was achieved (5.56% vs 31.8%, p=0.001). The number of patients getting access to multidisciplinary care and discussions via teleconference increased dramatically (5.56% versus 86.4%, p=0.0001). A trend toward a shorter median time from first symptoms to diagnosis was found (1.75-month vs 1-month, p=0.85). In addition, significant changes in the underlying pathology were recorded. Before and after centralization embryonal tumors, low-grade gliomas and high-grade gliomas accounted 37% vs 24.25%, 22.2% vs 31.8% and 11.1% vs 15.15% of CNS tumors, respectively. The availability of follow-up information marginally increased after centralization (83.3% vs 87.8%, p=0.48). CONCLUSIONS CNS tumors especially low-grade gliomas were frequently not registered before centralization. The current study proves that centralization helps to improve CNS tumors registration, diagnosis, and evaluation as well as facilitating multidisciplinary care. Further research is needed for evaluating the survival benefits of centralization.