Multidisciplinary Rehabilitation vs. Standard Care in Pediatric CNS Tumor Survivors: A National Cohort Study from Kazakhstan.
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BACKGROUND: Childhood survivors of CNS tumors are at high risk for long-term neurological, cognitive, and functional impairments. In Kazakhstan and many low- and middle-income countries (LMICs), standardized rehabilitation services and outcome tracking systems are largely lacking. To assess the effectiveness of Kazakhstan's inaugural national multidisciplinary rehabilitation program for children with CNS tumors, utilizing data from a newly established pediatric oncology registry. METHODS: This retrospective cohort study with prospective follow-up included 600 children aged 3-17 years with CNS tumors. The intervention group (n=300) received structured rehabilitation, which encompassed physiotherapy, physical education, speech therapy, neuropsychological therapy, psychological support, hippotherapy, sensory integration, and occupational therapy. The control group (n=300) received standard post-treatment follow-up without rehabilitation. Outcomes were assessed using the Pediatric Evaluation of Disability Inventory (PEDI), Pediatric Quality of Life Inventory (PedsQL), the OncoLife caregiver questionnaire, and neuropsychological testing. During the study period, standard care in Kazakhstan included routine oncological follow-up visits, symptom-driven neurological consultations, and general medical management. However, structured multidisciplinary rehabilitation services were not systematically available. RESULTS: All children in the intervention group completed the rehabilitation program without experiencing serious adverse events. Compared to the control group, the rehabilitation group demonstrated significantly greater improvements in functional independence (+14.23 PEDI points), quality of life (+20.04 PedsQL points), caregiver-reported outcomes (+15.23 OncoLife points), and cognitive performance (+17.75 neuropsychological points) (all P<0.001). Clinical gains included restored ambulation, enhanced communication, and improved school participation. Based on these results, a national rehabilitation protocol was endorsed by the Ministry of Health and integrated into pediatric oncology care. CONCLUSION: The national implementation of multidisciplinary rehabilitation for pediatric CNS tumor survivors in Kazakhstan has significantly improved health and functional outcomes without raising safety concerns. These findings advocate for the integration of rehabilitation into pediatric oncology care in low- and middle-income countries (LMICs).