The Initial Management of Paediatric Acute Leukaemia in Regional and Remote North Queensland, Australia: How Can We Improve? A Multi-Centre Retrospective Cohort Study.

INTRODUCTION

Acute leukaemia (AL) is the most common childhood cancer globally. Children with AL who live outside of a major city experience poorer survival rates. Current literature exploring this survival discrepancy focuses on variables related to the patient and family. There is a gap in our understanding of the role of the non-metropolitan healthcare centre. Our study aims to identify how children with AL were initially managed in regional northern Queensland (NQ) hospitals, Australia. Our goal is to provide the necessary foundation for improvements in service delivery and reduce survival discrepancy associated with rurality.

METHOD: A multi-centre retrospective cohort study of all patients aged ≤ 16 years with AL who presented to all major NQ hospitals between June 2016 and July 2023 was conducted. Clinical and laboratory characteristics on initial presentation alongside initial management were collected from medical records and compared to internationally recognised gold standard recommendations.

RESULTS

This study identified 40 patients. Children with febrile neutropenia received antibiotics at a median time of 3.5 h from initial presentation. There was no difference in fluid delivery (p = 0.29) or chest imaging (p = 0.20) in children with leucocytosis and/or peripheral blasts compared to children without these high-risk laboratory features. There was a difference in allopurinol administration (p = 0.04) dependent on leucocytosis and/or peripheral blast status. Eight (20.0%) children and their families did not receive social work support.

CONCLUSION

Initial management of children presenting with AL to regional NQ hospitals differed from gold standard management. This study expands on existing dialogue through identifying which key areas of initial management require focused improvement regionally. Implementation of site-specific guidelines on initial management reflecting these findings may improve patient health outcomes regionally.