Healthcare perceptions on surgical management for children diagnosed with neuroblastoma in South Africa

Abstract

Background

Surgical management in neuroblastoma predicts survival and determines morbidity globally but is not standardized in South Africa. We evaluated South African healthcare workers’ perceptions of surgical management of neuroblastoma.

Methods

A national survey on neuroblastoma surgical practices were developed by Delphi method and distributed to medical and surgical healthcare workers managing children diagnosed with neuroblastoma.

Results

Thirty-five surveys were completed: 17 (49 %) were medical and 18 (51 %) were surgical disciplines. The median experience was 7.5 years (range 1–22 years). Twenty (57 %) respondents managed less than 5 cases/year. Twenty-seven (77 %) dealt with mainly metastasized tumours. The majority of tumours had more than one image-defined risk factor at presentation. Sixteen (46 %) stated that their decision to perform surgery was influenced by gaining metastatic complete remission , next followed by vascular encasement (25 %).

Barriers to surgery were a lack of neuroblastoma-specific surgical skills (77 %), tumour operability (50 %) and operating time (21 %). Roughly half i.e. 49 % (n = 17) of respondents were in favour of centralizing neuroblastoma surgical management. Twenty-six (74 %) reported surgical management as part of a multi-disciplinary team until patients were discharged from intensive care. The number of years of a respondent's experience influenced the degree of resection achieved in HR tumours (p = 0.021).

Conclusions

Non-standardized surgical practice in neuroblastoma management exists in South Africa. Optimizing surgical resources, management and skills may improve surgical outcomes.