Abstract 62: Minding the Gap: Implementation of Sequencing-Based Diagnostics for Pediatric Cancer in Resource-Limited Settings
Authors: Busby Kenneth , Navas Angelo , Bhakta Nickhill , Duffy Caitlyn , Aijaz Javeria , Klüssmann Federico Antillón , Alexander Thomas , Roberts Megan 
Published: June 2023

Abstract
Purpose: Overall survival for pediatric cancer in low- and middle-income countries (LMICs) remains at 30%, compared to 80% in high-income countries in part from limited access to appropriate diagnostics. Genome sequencing-based diagnostics can provide comprehensive classification for pediatric cancer which leads to more effective treatment selection. Our aim is to understand barriers and opportunities for implementation of genomic sequencing for pediatric cancer classification in LMICs to contribute to improved survival for children with cancer.
Methods: Across World Bank income classification regions, twelve partner sites contributed. Site champions completed surveys to identify available resources and needs for implementation of genomic-based sequencing. Semi-structured interviews with key implementation partners at six sites are being conducted. Twelve interviews across two sites have been completed using an interview guide informed by the Consolidated Framework for Implementation Research (CFIR). Rapid qualitative analysis is being performed to identify key themes regarding implementation needs and strengths.
Results: Survey findings revealed 6,159 children diagnosed per year across LMIC partner sites (n=11). There was an overall mean of 266 diagnoses per year for leukemia/lymphoma, 219 diagnoses per year for non-CNS solid tumor cases, and 105 diagnoses per year for CNS tumors (n=11). All sites had access to morphology, 92% had access to immunohistochemistry, 83% had access to flow cytometry, 58% had access to cytogenetics, and 75% of sites had access to PCR, microarray, or DNA mutation panels. All sites had some level of access to research personnel/laboratory equipment, 75% of sites had genome sequencing experience, and 58% of sites had a tumor repository.
Qualitative analysis of interviews (n=7) from the first partner site identified several key themes. Major implementation needs were human resource training and site-level implementation costs. Current strengths included buy-in from administration and support for the relative advantage of sequencing technology compared with locally-available standard of care. Most collaborators were optimistic that sequencing-based diagnostics would be feasible to implement. Collection of qualitative data and analysis is ongoing.
Conclusion: Determination of effective implementation strategies for sequencing-based diagnostics in LMICs will contribute to improved survival for children with cancer.
Citation Format: Kenneth Busby, Angelo Navas, Nickhill Bhakta, Caitlyn Duffy, Javeria Aijaz, Federico Antillón Klüssmann, Thomas Alexander, Megan Roberts. Minding the Gap: Implementation of Sequencing-Based Diagnostics for Pediatric Cancer in Resource-Limited Settings [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 62.