Treatment Decision Making at Diagnosis for Children Presenting With Advanced Cancer in Low-and Middle-Income Countries

Sep 22, 2026

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Although most children diagnosed with cancer live in low- and middle-income countries, research on treatment decision making in these settings remains limited. This qualitative study examines how physicians approach decisions when children present with advanced cancer at diagnosis in LMICs, where local centers may lack resources to deliver curative treatment and existing guidelines may not reflect contextual variation. Semi-structured interviews with 36 physicians informed inductive analysis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

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Original Reports | Pediatric Oncology Treatment Decision Making at Diagnosis for Children Presenting With Advanced Cancer in Low-and Middle-Income Countries Marta Salek, MD, MPH1 ; Ana Caceres-Serrano, PhD2 ; Joanne Canedo, PharmD, MS3; Lucia Fuentes, MSc2; Shoshana Mehler, BS1 ; Alaina Rule, MD4; Jamie Zeal, MD, MS5 ; Carlos Rodriguez-Galindo, MD1 ; Dylan Graetz, MD, MPH1 ; Nickhill Bhakta, MD, MPH1 ; Erica C. Kaye, MD, MPH1 ; and on behalf of the CATALYST Advisory Group DOI [https://doi.org/10.1200/GO-25-00320](https://doi.org/10.1200/GO-25-00320) | ABSTRACT | | | --- | --- | | PURPOSE | Although most children diagnosed with cancer live in low-and middle-income countries (LMICs), research exploring decision making in these settings remains sparse. When children present with advanced cancer in LMICs, local centers may lack resources to provide treatment required to achieve cure. Existing treatment guidelines often do not account for contextual and resource variations inﬂuencing decision making. This qualitative study sought to understand physician approaches to treatment decision making for children presenting with advanced cancer at diagnosis in LMICs. | | METHODS | Semistructured interviews were conducted with 36 physicians caring forchildren with cancer across all world regions and representing diverse income levels. Interviews were conducted in English, audio-recorded, and transcribed. Inductive content analysis focused on decision-making approaches. | | RESULTS | Most participants were female (n 5 24; 67%), older than 36 years (n 5 32; 89%), and practiced at centers caring for >100 new childhood cancer cases annually (n 5 26; 72%) in lower-middle–income countries (n 5 20; 55%) . A spectrum of cancers were reported as advanced at diagnosis, with no single diagnosis predominating. Physicians generally recommended four treatment approaches (eg, curative-intent, non–curative-intent, referral, or limited chemotherapy trial), resulting in seven outcome pathways based on whether a family accepted, challenged, or declined the proposed treatment. Four decisionmaking approaches (eg, physician-led, family-led, participatory, or externally inﬂuenced) informed determinations of goals of care focused on optimizing prognostic outcomes, providing individualized care, and committing to treating all children, irrespective of differences in patient/family circumstances. | | CONCLUSION | Physicians caring forchildren with cancer in LMICs navigate complex treatment decision making, considering diverse treatment paths and goals. Pragmatic, evidence-based interventions are needed to guide decision making, ﬂexible to local constraints. | ACCOMPANYING CONTENT Appendix Reﬂexivity Statement Accepted October 27, 2025 Published March 19, 2026 JCO Global Oncol 12:e2500320 © 2026 by American Society of Clinical Oncology Licensed under the Creative Commons Attribution 4.0 License INTRODUCTION Treatment decision making is a core facet of high-quality pediatric cancer communication and integral to culturally adapted, patient-centered care.1-3 At present, most research focused on clinical decision making in pediatrics and pediatric oncology originates in high-income countries (HICs), and its application and relevance in resource-constrained or culturally diverse settings remains understudied.4-7 An estimated 90% of children diagnosed with cancer live in lowand middle-income countries (LMICs), yet research on decision making in these settings is sparse, with a recent review revealing only 11 studies related to decision making in pediatric cancer in LMICs.8-10 Children with advanced or poor prognosis cancer at diagnosis and their families face particularly challenging circumstances around treatment decision making in LMICs as local centers often lack capacity to provide curative options or access to clinical trials.9,11-15 Administration of therapy misaligned with local capacity can worsen treatment-related morbidity and

FAQs

What was the study’s primary purpose?

To understand how physicians make treatment decisions for children presenting with advanced cancer at diagnosis in low- and middle-income countries (LMICs).

How was the study conducted?

The study used semi-structured interviews with 36 physicians across regions and income levels, with inductive content analysis of decision-making approaches.

What decision-making approaches and outcomes were identified?

Physicians generally recommended several treatment approaches, leading to outcome pathways depending on whether families accepted, challenged, or declined proposed treatment. Four decision-making approaches helped shape goals of care focused on prognostic outcomes, individualized care, and commitment to treat children regardless of circumstances.

Sep 22, 2026

Upload by Kyle