Implementation of a Shared Care Network in Pediatric Oncology Through a Hub‐and‐Spoke Model in a Resource‐Limited Setting: A Multicenter Descriptive Study From Pakistan

BACKGROUND: Access to pediatric oncology services is limited in resource-constrained lower middle-income countries like Pakistan. A hub-and-spoke shared care network (SCN) was implemented in the province of Sindh by Indus Hospital & Health Network (IHHN) with the support of My Child Matters Grant (FoundationS), to decentralize selected services, strengthen local capacity, and improve access to care closer to patients' homes. METHODS: A multicenter, retrospective descriptive study was conducted from July 2023 to December 2024. IHHN served as the Level III hub, supporting four shared care centers (Level I-Larkana and Shikarpur, and Level II-Civil Hospital Karachi and Nawabshah). Pediatric patients ≤16 years seen at SCCs or referred between SCCs and the hub were included; patients managed solely at the hub were excluded. Descriptive and inferential statistics summarized patient characteristics, visit patterns, and treatment outcomes. RESULTS: A total of 284 patients accessed the SCN (Level I: 91 and Level II: 193), with a median age of 7 (interquartile range [IQR]: 4-12) years; male:female ratio 1.4:1. Across 1519 visits, 86% were outpatient/daycare, with higher average visits per patient at Level II centers. Acute leukemia was most common (53%, with no statistically significant variation in diagnostic distribution across levels of care (p = 0.106). However, significant variation was observed in visit types (p < 0.001) and treatment outcomes (p < 0.015) across levels. At analysis cutoff, 58% were in first complete remission, 10% abandoned treatment, 9% relapsed, and 7% died during curative therapy. Forty-six staff participated in capacity-building training. CONCLUSIONS: The shared care network is a feasible approach to expand pediatric oncology services in resource-limited settings. It enhanced access, supported local capacity building, and maintained continuity of care, demonstrating potential for scale-up in similar contexts.