Every year about 400,000 children below the age of 19 years are estimated to be diagnosed with cancer. >80% of children diagnosed from high income group (HIC) countries will become long term survivors. However, 80% of the incidence occur in Low and medium income group countries (LMIC) and only 15-40% of children may be cured. This major discrepancy in treatment outcome between the two is due to lack of awareness on childhood cancer amongst the public, misdiagnosis and/or delay in diagnosis, malnutrition, lack of access to healthcare and supportive care, treatment refusal and abandonment.
Developing a comprehensive cancer control strategy n eeds an understanding of local incidence and burden of cancer in the community. An approximate incidence of childhood cancer incidence in India is estimated based on population based and hospital based cancer registries along with global estimates and local population estimates. Accordingly, it has been estimated that closer to 50,000 children between 0-14 years of age and just over 75,000 children between 0-19 years of age may develop cancer every year in our country. Only about 50% of children are diagnosed and registered and the other 50% never make the diagnosis or die before it is confirmed.
Childhood cancer is predominantly not preventable or amenable to screening strategies, however early recognition and prompt diagnosis of cancer and referral may improve survival. Establishment of collaborative, multi-centre studies and trials have paved the way for ongoing research in India. Holistic approach at extending support through charity groups aimed at improving survival in pediatric oncology by supplementing for nutritional care, education, accommodation and financial help has reduced abandonment and worth mentioning. While intensive chemotherapy regimens may drastically improve survival outcome closer to HIC, malnutrition and lack of adequate supportive care measures may limit the approach. Hence reducing intensification of treatment protocols thereby reducing toxicity related death is a pragmatic balance.
Closer to over 3600 children are diagnosed with cancer every year in the state of Tamil Nadu. Majority of them are treated in major cities where pediatric oncology centers are located, hence necessitating temporarily relocating the family’s livelihood until treatment would be completed. This is supported by data that childhood cancer outcome is better when children are treated by pediatric oncologists with adequate supportive care in a pediatric oncology unit. Many LMICs have developed the concept of shared care. This is still at a nascent stage in our country and will need intense training of doctors, patients and nurses, strict monitoring of protocols, educating family, community and their family physicians/ local hospitals. This may help reduce financial burden on the family and has proven to reduce abandonment rate by at least more than 25% in LMIC like Guatemala and other Latin American countries.
At Gleneagles Global Health City, Chennai, we are educating the public on earliest signs to detect cancer, networking with Paediatricians and physicians across various towns and cities in Tamil Nadu conducting webinars on childhood cancer, creating awareness through social media and writing newsletters.
Children – they all matter. Let’s beat childhood cancer together!
By Dr. Ponni Sivaprakasam, Senior Consultant – Paediatric oncology, Department of Paediatric Hemato Oncology, Gleneagles Global Health City, Chennai
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