Alarming Findings of Psycho-socio-spiritual Interventions on Physical, Mental and Social Health for Children with Cancer and Their Families in Low-and Middle-Income Countries:; A Meta-Analysis

Hisham Morsi ^1,2,3* Tooba Nadeem Akhtar ^3,4 Harriet Dean Miller ³ Ozge Balkaya ³ Jeanine Clapsaddle ^3,5 Holly Clark ³

• ¹ Hamad Medical Corporation, Doha, Qatar
• ² Kingston University, Kingston upon Thames, England, United Kingdom
• ³ Pediatric Potential, Plymouth, United States
• ⁴ Trinity Centre for Health Sciences, Trinity Research in Childhood Centre, School of Psychology, Trinity College Dublin, Dublin, Ireland
• ⁵ Institute of Child Development, College of Education and Human Development, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States

Background: Children residing in Low-and Middle-Income Countries (LMICs) are at a higher risk of cancer. The provision of psycho-socio-spiritual care to address stressors accompanying a cancer diagnosis is largely unknown in these countries and the evidence on psycho-socio-spiritual interventions in LMICs remains unexplored. Objective: This meta-analysis aimed to synthesize findings on psycho-socio-spiritual interventions for children and families with cancer in LMICs in comparison with resources rich developing nations. Design: A prospective comprehensive meta-analysis. Setting(s): Lowand -Middle -Income countries and Resource Rich Developing Countries as per the World Bank classification Participants: 18 studies that recruited 3072 children (0-18) with cancer or their family members and carers were included in this meta-analysis. Methods: A Systematic search of five databases PubMed, PsycINFO, CINAHL, Cochrane Databases, and a grey literature ProQuest was conducted to identify all possible hits. Following screening, data were extracted on a comprehensive list of variables to allow pooled and moderation analysis. The meta-analysis was performed via CMA-v2, quality of included studies was assessed via the Cochrane software "Risk of Bias-v2.0 (RoB2)" and PRISMA and AMSTAR 2 guidelines were followed throughout. Results: A highly significant OR of 4.933 (95% CI: 3.423 -7.108, p < 0.0001), indicated ~fivefold improvement in children and families with cancer in 11 LMICs as a result of the psycho-socio-Classified as C0 Public by Hamad Medical Corporation spiritual interventions. Four more LMICs showed evidence of qualitative psycho-socio-spiritual services for children with cancer. The quality of evidence was rated as 2B in most of the eligible studies. We established a model that can test >400,000 combination of factor Conclusions: The childhood oncology community are alerted at the lack of equitable holistic care for children and families with cancer in 126 out of the 137 LMICs and seize the opportunity to target the underserved populations through development, adaptation, and investment in psycho-socio-spiritual care. Our model can aid future studies and policy making.