Implementation of a Shared Care Network in Pediatric Oncology Through a Hub‐and‐Spoke Model in a Resource‐Limited Setting: A Multicenter Descriptive Study From Pakistan
Syed Ahmer Hamid, Naeem Jabbar, Hebah Mushtaque, Zoreen Shafaq, Zarin Inam, Eric Bouffet, Muhammad Shamvil Ashraf, Ghulam Qadir Pathan, Muhammad Rafie Raza, Sadia Imran, Sundus Hashmani, Fozia Korai, Naseer Jatoi, Mughal Khan, Bashir AhmedABSTRACT
Background
Access to pediatric oncology services is limited in resource‐constrained lower middle‐income countries like Pakistan. A hub‐and‐spoke shared care network (SCN) was implemented in the province of Sindh by Indus Hospital & Health Network (IHHN) with the support of My Child Matters Grant (FoundationS), to decentralize selected services, strengthen local capacity, and improve access to care closer to patients’ homes.
Methods
A multicenter, retrospective descriptive study was conducted from July 2023 to December 2024. IHHN served as the Level III hub, supporting four shared care centers (Level I—Larkana and Shikarpur, and Level II—Civil Hospital Karachi and Nawabshah). Pediatric patients ≤16 years seen at SCCs or referred between SCCs and the hub were included; patients managed solely at the hub were excluded. Descriptive and inferential statistics summarized patient characteristics, visit patterns, and treatment outcomes.
Results
A total of 284 patients accessed the SCN (Level I: 91 and Level II: 193), with a median age of 7 (interquartile range [IQR]: 4–12) years; male:female ratio 1.4:1. Across 1519 visits, 86% were outpatient/daycare, with higher average visits per patient at Level II centers. Acute leukemia was most common (53%, with no statistically significant variation in diagnostic distribution across levels of care ( p = 0.106). However, significant variation was observed in visit types ( p < 0.001) and treatment outcomes ( p < 0.015) across levels. At analysis cutoff, 58% were in first complete remission, 10% abandoned treatment, 9% relapsed, and 7% died during curative therapy. Forty‐six staff participated in capacity‐building training.
Conclusions
The shared care network is a feasible approach to expand pediatric oncology services in resource‐limited settings. It enhanced access, supported local capacity building, and maintained continuity of care, demonstrating potential for scale‐up in similar contexts.