ID #495 Pediatric Neuro-Oncology Service Capacity in LMICs: Results from PANORAMA Across 21 Countries

Abstract Background Identifying gaps in services that limit clinical care is essential to improve outcomes for children with central nervous system (CNS) tumors. The PediAtric Neuro-Oncology seRvices AssessMent Aid (PANORAMA), a comprehensive service evaluation tool, was used to assess pediatric neuro-oncology capacity across low- and middle-income countries (LMICs). Methods We conducted an assessment of institutions in LMICs between October 2025 and January 2026 using PANORAMA, which comprises 322 questions spanning the continuum of pediatric neuro-oncology care. Results A total of 34 institutions in 21 countries participated, located in Asia (47.1%), Africa (26.5%), Latin America (23.5%), and Europe (2.9%), and representing upper-middle-income (47.1%), lower-middle-income (47.1%), and low-income (5.9%) countries. Participating institutions included general (35.3%), oncology (26.5%), pediatric oncology (17.7%), and pediatric (17.7%) hospitals. The mean annual number of new CNS tumor cases was 70. Nineteen institutions (55.9%) had an established referral network. Specialist availability varied: 88.2% reported access to a neurosurgeon, 64.7% to a pediatric neurosurgeon, 97.1% to a pediatric oncologist, 67.7% to a pediatric neuro-oncologist, 82.4% to a radiation oncologist, 58.8% to a pediatric radiation oncologist, 100% to a pathologist, and 55.9% to a neuropathologist. Thirty institutions (88.2%) had a multidisciplinary team that met regularly to discuss patient management. Twenty-eight institutions (82.4%) had access to MRI, with 78.8% reporting turnaround times of 2–7 days. Seven (20.6%) institutions had access to methylation profiling. Nineteen (55.9%) centers were able to perform autologous bone marrow transplantation. Five (14.7%) institutions reported that fewer than 75% of patients with medulloblastoma initiated curative-intent treatment. Conclusions Pediatric neuro-oncology resources across LMICs are heterogeneous. While most institutions reported access to core services, significant gaps persist, particularly in advanced diagnostics and treatment delivery. These findings provide a foundation to inform priority setting and support the development of interventions to improve outcomes for children with CNS tumors.