ArticleSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2024
Exploring treatment decision-making at diagnosis for children with advanced cancer in low- and middle-income countries.
Article in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Treatment Decision Making at Diagnosis for Children Presenting With Advanced Cancer in Low- and Middle-Income Countries.JCO global oncology · 2026Article
- Evaluation of the effectiveness of the model of family participatory care based on cloud follow-up in enhancing the quality of life and psychological well-being of patients with chronic difficult-to-heal traumatic tumours.Frontiers in public health · 2026Observational
- Burden of prolonged treatment delay among patients with common cancers in the Philippines.Cancer causes & control : CCC · 2025Article
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Authors and funding
18 authors.
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Abstract
purposeGlobal childhood cancer survival outcomes correlate with regional contextual factors, yet upfront treatment decision-making for children with advanced or poor prognosis cancer in low- and middle-income countries (LMICs) is not well understood. This study aimed to (1) characterize the landscape of contextual factors that shape physician decision-making at diagnosis for these children in LMICs and (2) describe physician rationales for if/when to offer treatment with non-curative intent, including how they define "poor prognosis" during treatment decision-making.
methodsAn international panel of pediatric oncologists practicing in LMICs participated in two focus groups structured for the collaborative generation of factors influencing treatment decision-making, including consideration of non-curative treatment pathways at diagnosis. Thematic analysis of qualitative data was conducted, followed by member checking.
resultsEleven pediatric oncologists participated, representing all global regions defined by the World Health Organization. Participants identified a broad range of factors influencing decision-making across multiple levels, including the individual, hospital, health system, community, and country levels. All participants agreed that treatment with non-curative intent could be offered at diagnosis in certain contexts, and diverse definitions for poor prognosis were described.
conclusionsUpfront treatment decision-making for children with advanced or poor prognosis cancer in LMICs is variable and challenging. Difficulties with decision-making in LMICs may be amplified by inconsistent definitions of poor prognosis and underrepresentation of the factors that influence treatment decision-making within existing decision-making frameworks or childhood cancer treatment guidelines. Future research should explore decision-making approaches, preferences, and challenges in depth from the perspectives of pediatric cancer patients, families, and multidisciplinary clinicians.
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