Essential Knowledge and Skills for the Practice of Pediatric Surgical Oncology: A Modified Delphi Consensus Study by the APSA Cancer Committee

Purpose: Childhood cancer care has become increasingly complex. However, the exclusive practice of pediatric surgical oncology is not feasible for most surgeons taking care of these children. Thus, the American Pediatric Surgical Association (APSA) Cancer Committee conducted a modified Delphi study to reach a national consensus on the essential knowledge, skills, and institutional setting for surgeons caring for children with cancer. Methods: After development of candidate statements, the APSA Cancer Committee conducted a modified Delphi process consisting of two classic rounds and a third consensus round. Statements were reviewed by an expert panel consisting of pediatric surgical oncologists, pediatric medical oncologists, pediatric surgery program directors, general pediatric, recent pediatric surgery graduates. Consensus was defined a priori as Cronbach’s alpha > 0.8 and greater than 80% panel agreement. Results: Initial candidate statements comprised eight domains including solid tumors, metastasis, and institution resources. After review by the expert panel consisting of 35 panelists from 24 institutions across 18 US states and Canada, 177 statements achieved consensus. Internal consistency was excellent (Cronbach’s alpha 0.989, 0.987, and 0.987 after rounds 1–3). A major emphasis of the consensus statements was on the importance of multidisciplinary care, including multidisciplinary surgical teams for complex resections, and knowledge of current tumor-specific management principles. Conclusions: This study represents the first national consensus study of the knowledge and skills essential for pediatric surgical oncology. These results should inform ongoing conversations about how best to match children with cancer to the surgeons equipped to care for them without creating additional barriers for families.