Improving the quality of care in the molecular era for children and adolescents with medulloblastoma

Abstract

PurposeElevated mortality and morbidity rates persist in pediatric patients with medulloblastoma. We present a clinical audit of a real-world cohort of patients in search for pragmatic measures to improve their management and outcome.Methods/patientsAll pediatric patients with medulloblastoma treated between 2003 and 2016 at a Spanish reference center were reviewed. In the absence of internationally accepted quality indicators (QIs) for pediatric CNS tumors, diagnostic, therapeutic, survival, and time QIs were defined and assessed.ResultsFifty-eight patients were included, 24% were younger children (<\u20093\xa0years), 36% high risk (anaplastic, metastasis, or surgical residue >\u20091.5\xa0cm2), and 40% standard risk. Five-year OS was 59.2% (95% CI 47–75); 5-year PFS 36.4% (95% CI 25–53). Five main areas of quality assurance were identified: diagnosis, global strategy, frontline treatment modalities, outcomes, and long-term and end-of-life care. A set of 34 QIs was developed and applied. Lack of central pathology review, delay in the incorporation of novel molecular markers, and absence of a neurocognitive and quality-of-life evaluation program were some of the audit findings.ConclusionsThis real-world research study resulted in the development of a pragmatic set of QIs, aimed to improve clinical audits and quality of care given to children and adolescents with medulloblastoma. We hope that our findings will serve as a reference to further develop a quality assurance system with specific QIs for pediatric CNS tumors in the future and that this will ultimately improve the survival and quality of life of these patients.