SIOP PODC Adapted treatment guidelines for low grade gliomas in low and middle income settings

Abstract Background The use of clinical practice guidelines in clinical and organizational decision-making improves the care of patients and patient safety. Guidelines make healthcare consistent and efficient. In many low- and middle income countries healthcare workers depend on guidelines developed in higher income countries. For these to be useful and accepted they need to be adapted to the local setting. The aim of the study was to implement pre-hospital treatment guidelines into an organization that was not currently using guidelines. The study was partnership between a Swedish pre-hospital training organization and local ambulance service organizations in Kosovo. Methods An iterative process of implementing the guidelines was used: Identify guidelines appropriate for the local organization.In sets of five, have the guidelines translated into Albanian.Adapt the guidelines to the local conditions and context.Approval of guidelines by an expert group.Begin using the guidelines within the target organization. Results The first set of five guidelines was translated, approved, and implemented into the organizations. To improve acceptance, both practitioners and decision-makers were involved in the process. Seven workshops were held, with a total of 104 participants. In follow-up discussions participants said they accepted the guidelines and that they would be useful in their daily work. Conclusions It is important to evaluate to what extent the guidelines have been accepted, understood, and used. The success and acceptance is due to the flexible procedure managing the full implementation process. Adapting guidelines to fit with local needs and requirements using local experts made the guidelines accessible and useful. The workshop discussions established justification and approval. Key messages Involve local experts in contextualising guidelines to increase acceptance from the start. Support building a robust local implementation organization to assist and administer change.

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SIOP PODC–adapted treatment guidelines for craniopharyngioma in low‐ and middle‐income settings

Pediatric Blood & Cancer ◽

10.1002/pbc.28493 ◽

2020 ◽

Author(s):

Nisreen Amayiri ◽

Ariane Spitaels ◽

Mohamed Zaghloul ◽

Anthony Figaji ◽

Sergio Cavalheiro ◽

...

Keyword(s):

Treatment Guidelines ◽

Middle Income ◽

Low And Middle Income

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Oncology Guidelines Usage in a Low- and Middle-Income Country

Journal of Global Oncology ◽

10.1200/jgo.17.00136 ◽

2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Nofisat Ismaila ◽

Omolola Salako ◽

Jimoh Mutiu ◽

Oladeji Adebayo

Keyword(s):

Treatment Guidelines ◽

Guideline Implementation ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Middle Income ◽

Patients With Cancer ◽

Radiation Oncologists ◽

Local Setting ◽

American Society ◽

Low And Middle Income

Purpose There is a paucity of data about current usage of oncology guidelines in low- and middle-income countries (LMICs), specifically in terms of the availability and quality of those guidelines. Our objective was to determine usage of oncology guidelines and the barriers and facilitators to their usage among radiation oncologists in LMICs. Methods An online cross-sectional survey was conducted among practicing radiation oncologists in Nigeria via e-mail and the social media database of the Association of Radiation and Clinical Oncologists of Nigeria. In addition, paper questionnaires were administered at regional clinical meetings. Results The survey response rate was 53.4% in a sample of 101 radiation oncologists from the database. Sixty-nine percent of respondents were consultants and 30% were residents. Approximately 43% had < 5 years’ experience. All of the respondents were involved in administering chemotherapy during the treatment of patients with cancer, whereas approximately half were involved in diagnosing cancer. Ninety-three percent reported using guidelines in treating patients, the top two guidelines being those from the National Comprehensive Cancer Network (90%) and the American Society of Clinical Oncology (50%). The two major barriers to guideline usage were that facilities were inadequate for proper guideline implementation and that the information in guidelines were too complex to understand. Potential facilitators included providing adequate facilities, developing local guidelines, and increasing awareness of guideline usage. Conclusion Our study shows that clinicians involved in the treatment of patients with cancer in LMICs are aware of cancer treatment guidelines. However, implementation of these guidelines hinders their usage because the facilities are inadequate, guidelines are not applicable to the local setting, and the information in the guidelines is too complex.

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LINC-09. TREATMENT AND OUTCOME IN CHILDREN WITH LOW-GRADE GLIOMAS IN WESTERN MEXICO: EXPERIENCE AT HOSPITAL CIVIL DE GUADALAJARA

Neuro-Oncology ◽

10.1093/neuonc/noaa222.444 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii379-iii379

Author(s):

Regina M Navarro-Martin del Campo ◽

Erika Casillas-Toral ◽

Ana L Orozco-Alvarado ◽

Fernando Sanchez-Zubieta ◽

Luis A Arredondo-Navarro ◽

...

Keyword(s):

Progression Free Survival ◽

Subtotal Resection ◽

Low Grade ◽

Who Grade ◽

Middle Income ◽

Female Ratio ◽

Low Grade Gliomas ◽

Middle Income Countries ◽

Tertiary Center ◽

Few Data

Abstract BACKGROUND Brain tumors are the most common solid tumors in childhood, 35% of them being low-grade gliomas (LGGs). Few data is available regard LGGs in low-and-middle-income countries. This study evaluates LGGs in a tertiary center in Mexico. DESIGN: A retrospective review of clinical files of 105 children diagnosed with LGG other than optic nerve glioma from 2007 to 2019 was done. RESULTS Median age at diagnosis was 7.2 years (from 5 months to 18 years). Male to female ratio was 0.75:1. WHO Grade I represented 68% of the cases. Anatomic sites were: posterior fossa (41%), supratentorial (43.5 %), spinal (8.5%), subependymal (6 %) and pineal (1%). Ten percent of patients had a diagnosed phacomatosis. Treatment was observation without surgery in 3.8%, surgery followed by observation in 49.5%, only chemotherapy in 2.8%, only radiotherapy in 6.7%, and surgery combined with chemotherapy or radiotherapy in 37.2% of cases. Among patients who had surgical intervention, 40% achieved gross total resection, 44% subtotal resection and 16% only biopsy. One or more recurrences were found in 20 % of patients. The 5 and 10-year overall survival (OS) was 83% and 73% respectively. The 5 and 10-year progression-free survival (PFS) was 66 % and 44 % respectively. CONCLUSIONS In this series the OS were lower compared with countries with high income, reflecting the need to improve surgery, since only 40% achieved complete resection that is a determining factor for the prognosis. We observed a decrease in OS until 10-year follow and the PFS was even lower due to recurrence/progression.

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Diffusely Infiltrative Low-Grade Gliomas in Adults

Journal of Clinical Oncology ◽

10.1200/jco.2005.05.2399 ◽

2006 ◽

Vol 24 (8) ◽

pp. 1236-1245 ◽

Cited By ~ 58

Author(s):

Frederick F. Lang ◽

Mark R. Gilbert

Keyword(s):

Randomized Trials ◽

Treatment Guidelines ◽

Standard Of Care ◽

Low Grade ◽

Resonance Imaging ◽

Who Grade ◽

Low Grade Gliomas ◽

Correlative Studies ◽

Evidenced Based ◽

Optimal Treatment Strategy

Diffusely infiltrating low-grade gliomas (LGGs) include astrocytomas, oligodendrogliomas, and mixed oligoastrocytomas (WHO grade 2). Due to the routine use of magnetic resonance imaging, there is an increasing need to formulate treatment guidelines for patients with LGGs. However, there is little consensus about the optimal treatment strategy for diffusely infiltrative LGGs, and the clinical management of LGGs is one of the most controversial areas in neurooncology. Although the standard of care has not been established, several randomized trials are beginning to provide some answers. Furthermore, laboratory correlative studies are defining subsets of LGG that may identify patients with better prognoses and increased chance of responding to therapy. This article reviews the most recent data regarding the treatment of LGG, emphasizing evidenced based approaches from current clinical trials.

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How Useful Are International Treatment Guidelines in Low- and Middle-Income Countries?

Journal of Global Oncology ◽

10.1200/jgo.2016.008250 ◽

2017 ◽

Vol 3 (5) ◽

pp. 441-443 ◽

Cited By ~ 5

Author(s):

Stewart Kerr ◽

Abdul-Rahman Jazieh ◽

David Kerr

Keyword(s):

Treatment Guidelines ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Oncology guidelines usage in a low and middle-income country.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18211 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18211-e18211

Author(s):

Nofisat Ismaila ◽

Omolola Salako ◽

Adebayo Oladeji

Keyword(s):

Cancer Patients ◽

Treatment Guidelines ◽

Guideline Implementation ◽

Healthcare Providers ◽

Developed Countries ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Middle Income ◽

Low And Middle Income

e18211 Background: Healthcare providers often rely on clinical practice guidelines to help inform and optimize patient care. However, most of these guidelines are from reputable organizations that are based in developed countries. There is a paucity of data about the status of guidelines in low and middle-income countries (LMIC), specifically in terms of their availability, usage and quality. Objective: To determine utilization of oncology guideline and potential barriers to usage in a LMIC among clinical and radiation oncologist (RADONCS) Methods: A cross-sectional survey was conducted with the use of an online questionnaire that was administered to practicing RADONCS in Nigeria via the Association’s email and social media database. In addition, paper questionnaires were administered in person at regional clinical meetings. Results: Survey response rate was 53.4% in a sample of 101 RADONCS from the database. Sixty-nine percent of respondents were consultants and 30% were residents. About 17% had greater than ten years’ experience managing cancer patients, while 43% had less than five years’ experience. All of the respondents are involved in the chemotherapy administration while only about half are involved in the screening and diagnosis of cancer patients. Ninety-three percent report using guidelines in managing patients and the top 3 guidelines used were National Comprehensive Cancer Network (90%), American Society of Clinical Oncology (50%) and European Society of Medical Oncology (46%). The major three barriers to guideline utilization were inadequate facilities for proper guideline implementation, the guideline is not applicable to setting and information in guideline is overwhelming. Potential facilitators include providing adequate facilities, developing local guidelines and increase awareness on the use of guidelines. Almost all respondents are in favour of using guidelines that are adapted to their practice setting. Conclusions: Our study shows that clinicians involved in the management of cancer patients in a LMIC are aware of cancer treatment guidelines. However, issues like inadequate facilities, inapplicability of guideline to local setting and complexity of information in guidelines hinder their usage.

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