From Fragmented Care to Structured Multidisciplinary Management: Evaluating the Impact on Pediatric Brain Tumor Outcomes in a Resource-Limited Setting
Abstract
Introduction: Pediatric brain tumors (PBT) represent a significant challenge in low and middle-income countries (LMICs) due to limited resources. This study evaluates the impact of establishing dedicated pediatric neuro-oncology multidisciplinary team (PNO-MDT) on treatment practices and survival outcomes at a tertiary care center in Pakistan.
Methodology: This retrospective analysis compared outcomes associated with Pediatric Brain Tumor cases at Aga Khan University Hospital, Karachi, between 2015-2024 versus 2004-2014 cohort. We included all patients aged ≤18 years with radiologically or histopathologically confirmed CNS tumors according to the WHO Classification and discussed in PNO-MDT. Multivariate Cox regression analyzed prognostic factors.
Results: Cohort of 652 patients were included in the final study from 2015-2024 and 175 from 2004-2014. The most common tumors were low-grade gliomas (23.2%), medulloblastomas (15.2%), and high-grade gliomas (12.7%). For post-PNO-MDT cohort, multidisciplinary team involvement occurred in 88.1% of cases. Median follow-up was 4.86 months, with 52.5% of post- PNO-MDT patients followed longer than one year compared to 17.1% pre-PNO-MDT. Treatment compliance significantly improved in the post-PNO-MDT cohort, with surgical intervention increasing from 78.9% to 87.4%.
Loss to follow-up decreased from 50% pre-PNO-MDT to 10.9% post-PNO-MDT implementation. Multivariate analysis identified significant prognostic factors: low-grade gliomas (HR=0.08, p<0.001), supratentorial location (HR=0.28, p<0.001), and ages 3-14 years (HR=0.45, p=0.019). Tumor board discussion improved survival (81.7% vs 69.4%, p=0.024). Survival outcomes showed improvement with 59.2% alive post- PNO-MDT compared to 19.9% pre- PNO-MDT, though mortality rates were 29.9% and 24%, respectively.
Conclusion: The implementation of PNO-MDT had a significant positive impact on patient outcomes. It led to increased pediatric tumor diagnosis and enhanced treatment compliance. Additionally, the structured and coordinated approach of the PNO-MDT effectively reduced loss to follow-up rates and substantially improved overall survival.
Conflict of Interest: None
Funding: None
Disclosure statement: None
License: This article is published under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0).
©️ Naureen Mushtaq, 2025. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to Cite
Mushtaq N, Minhas K, Qureshi BM, Bashir F, Ahmed A, Fatima S, et al. From Fragmented Care to Structured Multidisciplinary Management: Evaluating the Impact on Pediatric Brain Tumor Outcomes in a Resource-Limited Setting. OncoDaily Med J. 2025. doi:10.69690/ODMJ-018-0915-5582