Evaluating the Impact of Virtual Tumor Boards: A Mixed-Methods Analysis of GAPNO’s Case Discussions
Abstract
Children with central nervous system (CNS) tumors in low- and middle-income countries (LMICs) face substantial disparities in access to specialized multidisciplinary care. Virtual multidisciplinary tumor boards (vMDTs) may help bridge these gaps. This study evaluated the impact of the Global Alliance for Pediatric Neuro-Oncology (GAPNO) vMDT. We conducted a mixed-methods analysis. Case-based and participant-level surveys assessed diagnostic and therapeutic impact, implementation feasibility, capacity building, and barriers for participation. Descriptive statistics and rapid qualitative analysis were performed. Sixty-one cases from 16 centers across 10 LMICs were discussed between March 2023 and September 2025. Most presentations involved new cases (86.9%), commonly low-grade gliomas and embryonal tumors. Clinical decision support was the primary reason for presentation, particularly for treatment guidance (85.2%) and diagnostic clarification (37.7%). Treatment modifications were recommended in 45.9% of cases, including changes in chemotherapy, radiotherapy, surgery, surveillance, and supportive care; 92.9% of recommendations were implemented successfully. Participants reported improved pediatric neuro-oncology knowledge, greater confidence in managing complex cases, and stronger international collaboration. Qualitative findings highlighted enhanced diagnostic caution, increased use of molecular testing, multidisciplinary collaboration, and broader system-level learning. Scheduling conflicts and time-zone differences were the most reported barriers. vMDT are a feasible and impactful model for improving pediatric neuro-oncology care in LMICs, as they can enhance diagnostic accuracy, facilitate evidence-based and consensus treatment decisions with local applicability, and strengthens clinician and institutional capacity. However, resource limitations constrain optimal care delivery, mandating the need for comprehensive strategies to expand service delivery capacity.