Multidisciplinary Tumor Boards in Pediatric Surgical Oncology: A Systematic Review of Approaches in Low-And Middle-Income Countries

Cristian Puerta ¹ Charbel Chidiac ² Casandra E Besse ¹ Arturo Klipstein ³ Lawrence Brown ⁴ Juan Carlos Fierro ^5,6 Daniel S Rhee ² Jaime Shalkow ^3*

• ¹ Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, United States
• ² Division of Pediatric General Surgery, Department of Surgery, School of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, United States
• ³ Division of Pediatric Surgery, Cancer Center, ABC Medical Center, Mexico City, México, Mexico
• ⁴ Division of General Surgery, Department of Surgery, School of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, United States
• ⁵ Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland, United States
• ⁶ Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute (NIH), Bethesda, Maryland, United States

Background: Pediatric cancer outcomes have improved significantly over recent decades, largely due to multidisciplinary collaborative efforts. Multidisciplinary Tumor Boards (MTBs) facilitate interdisciplinary discussions, leading to better treatment plans. However, their feasibility and effectiveness in low-and middle-income countries (LMICs) remain less established. This systematic review aims to evaluate existing literature on the implementation and use of MTBs in LMICs, to better understand the current landscape and devise implementation strategies to increase their use and positively impact patient outcomes. Methods: This study followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting guidelines. A comprehensive literature search in PubMed, Google Scholar, and SciELO was conducted for English and Spanish publications, including quantitative and qualitative studies on pediatric MTBs in LMICs. Search terms included "MTBs", "Pediatric MTBs", and "LMICs". Interventional and observational studies were considered, with no restrictions on publication date. Articles that did not report results or were performed in adult populations were excluded. Results: Eight of the 2,699 studies initially identified were included in the review. Across the reviewed literature, 1063 patient cases were reported to be evaluated in MTBs. Ninety minutes was the most common meeting duration reported. Most MTBs were attended at least by a pediatric oncologist, a pediatric surgeon, a radiologist, a radiation oncologist, and, in some cases, a pathologist. MTBs were reported to improve patient care and treatment standardization. Nevertheless, significant challenges for implementing MTBs in LMICs, such as limited resources, lack of protected time, and unreliable internet access, were identified. Conclusion: MTBs are crucial for advancing childhood cancer care in LMICs. Addressing challenges such as resource constraints and securing protected time for meetings is essential for optimizing patient outcomes.