(1288) Challenges in Pediatric Oncology Critical Care: A Two-Year Experience Using PROACTIVE Worldwide

Introduction: Nearly 90% children with cancer reside in low and middle-income countries, which face multiple challenges delivering high quality pediatric onco-critical care (POCC). The PediatRic Oncology cApaCity Assessment Tool for IntensiVe CarE (PROACTIVE) was launched in 2021 to help organizations evaluate strengths and limitations in POCC services. We describe common global challenges in POCC services in resource-variable settings identified using PROACTIVE in 2022-2023.

Methods: PROACTIVE is an electronic tool divided into 2 surveys for intensivists and oncologists managing critically ill pediatric hematology-oncology patients. The tool, available in English and Spanish language, is arranged into 8 domains with answer options in the dichotomous, numerical, and Likert scale, and its center-specific report highlights areas of opportunity for improvement. Aggregated data from 46 centers that completed PROACTIVE between 2022 - 2023 were retrospectively analyzed and summarized. Indicators with a mean score ≤ 75% in accessibility or performance across all centers were classified as common global challenges in POCC.

Results: Aggregated data across 46 centers from 23 different countries of varying economic levels and pediatric critical care services were analyzed for performance comparison. Most prevalent challenges included: 1) Lack of updated guidelines to direct care of critically ill PHO patients such as chemotherapy-related toxicities (available in 48% of centers), 2) absence of abstinence and withdrawal symptoms monitoring (48%), 3) Inability to obtain blood products emergently within 1 hr (43%), 4) Inability to monitor increased intracranial pressure and deep venous thrombosis (43%), 5) Lack of multidisciplinary rounds to discuss clinical course with parents (35%), 6) Lack of nurses with up to date certification in pediatric cardiorespiratory resuscitation (33%), 7) Inability to obtain emergent laboratories within 1 hr (33%).

Conclusions: PROACTIVE is a contextually appropriate diagnostic tool that can help clinicians and hospitals identify challenges in POCC services. Aggregated PROACTIVE data identified common organizational challenges that can be used to develop global interventions focusing on the low-scoring indicators to improve POCC services and outcomes for critically ill children with cancer.