Management of children with brain tumors in Paraguay

Background. Cure rates among children with brain tumors differ between low-income and high-income countries. To evaluate causes of these differences, we an- alyzed aspects of care provided to pediatric neuro-oncol- ogy patients in a low middle-income South American country. Methods. Three methods were used to evaluate treat- ment of children with brain tumors in Paraguay: (1) a quantitative needs assessment questionnaire for local treating physicians, (2) site visits to assess 3 tertiary care centers in Asuncion and a satellite clinic in an un- derdeveloped area, and (3) interviews with health care workers from relevant disciplines to determine their per- ceptions of available resources. Treatment failure was defined as abandonment of therapy, relapse, or death. Results. All 3 tertiary care facilities have access to che- motherapy and pediatric oncologists but lack training and tools for neuropathology and optimal neurosurgery. The 2 public hospitals also lack access to appropriate ra- diological tests and timely radiotherapy. These results demonstrate disparities in Paraguay, with rates of treat- ment failure ranging from 37% to 83% among the 3 facilities. Conclusions. National and center-specific deficiencies in resources to manage pediatric brain tumors contribute to poor outcomes in Paraguay and suggest that both national and center-specific interventions are warranted to improve care. Disparities in Paraguay reflect different levels of governmental and philanthropic support, program development, and socio-economic status of pa- tients and families, which must be considered when de- veloping targeted strategies to improve management. Effective targeted interventions can serve as a model to develop pediatric brain tumor programs in other low- and middle-income countries.