Barriers to care to pediatric brain tumors in low- and middle-income countries: A proposal for a critical framework.
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BACKGROUND: Pediatric brain tumors (PBTs) represent the most prevalent solid cancers among children. Eighty percentages of those patients live in low- and middle-income countries (LMIC). There is a robust body of literature exploring the barriers to care (BTCs) to surgical pathologies in LMIC that include directly or indirectly PBT. All authors agree that systemic barriers worsen PBT care in LMIC. We aim to determine which are the three most frequently identified BTCs in the 2010-2025 literature, define a common conceptual problem to all of them, and propose an alternative framework. METHODS: A narrative review on BTCs to PBT in LMIC across MEDLINE, PubMed Central, Cochrane Library, Google Scholar, and Embase was performed for English-language publications from 2010 and 2025. RESULTS: We identified 122 papers relevant to our work. The most common BTCs can be grouped as (1) delayed diagnosis and referral due to misidentification of symptoms, limited diagnostic tools, and lack of national databases, (2) scarcity of neurosurgical personnel and adequate equipment for treatment, and (3) lack of formal pediatric neuro-oncology programs or infrastructure to guide both physicians and families. All of the above indicate that the problem of BTCs in LMICs is a structural problem related to national public health policies. CONCLUSION: The most efficient solution to BTCs to PBT stems from a change of national health policy.