A conceptual framework of evidence synthesis for using real-world data to improve childhood cancer health outcomes and resource use in Egypt
Background: Given the large number of children with cancer in Egypt, the limited resources, and the inferior survival outcomes, there is an urgent need to better utilise available resources to improve care and outcomes efficiently based on evidence. However, there is a gap in knowledge about childhood cancer survival outcomes and resource use in Egypt, due to paucity of published literature. Just as different locks need different keys to unlock them, different problems need different solutions to address them.
Objectives: To develop a conceptual framework of evidence synthesis that generates high-quality evidence relevant to local context to improve childhood cancer health outcomes and resource use in a resource-limited setting in Egypt.
Methods: I reflected on six key concepts of evidence-based medicine (EBM), and the Oxford Centre for Evidence-based Medicine 2011 levels of evidence, as a reference to generate and assess high-quality evidence.
Results: The conceptual framework of evidence synthesis (illustrated in Figure 1) uses hybrid research methods to generate three types of evidence: (1) real-world evidence from a local context to assess the current status of childhood cancer health outcomes, resources used/costs, and cost-effectiveness estimates; identify local priority areas; and provide evidence-based recommendations for improvement; (2) external evidence from the literature to provide the currently best available evidence about a key priority area; and (3) practical knowledge from expert opinion based on local clinical experience to help translate the generated evidence into practice and address the implementation gaps.
Conclusions: This conceptual framework could serve as a roadmap to generate high-quality evidence relevant to local contexts in similar resource-limited settings among low- and middle-income countries (LMICs), with an identified gap in published literature. Implementing this framework of evidence synthesis will help make better informed decisions to promote value in care delivery for children with cancer in these resource-limited contexts.
Patient, public and/or healthcare consumer involvement: Ideally, the opinions of other key stakeholders, such as consumers (patients and families) and payers, should be considered during the implementation phase of this framework. However, this should be cautiously addressed as cultural and socioeconomic barriers can exist in these LMICs.