General Health

How to improve Paediatric Cancer outcomes in India?

Successfully treating cancers depends on early detection. Paediatric cancer is one of those cancers that can be treated and cured easily once detected with around 84% survival rate (the survival rate in adults with cancer is around 20%). The incidence of Paediatric cancers is around 140 cases per million children. Common childhood cancers include leukaemia, lymphomas and brain tumours in children, osteosarcoma in teenagers and neuroblastoma in infants. 

MedPiper Technologies and JournoMed in collaboration with Medanta had conducted a webinar titled “Paediatric Cancer Care” on February 4th, 2022 where expert speaker, Dr. Satya Prakash Yadav spoke about  the types of childhood cancers and the roadblocks for cancer treatment in India. Dr. Satya Prakash Yadav is Director of Paediatric Haemato-Oncology and Bone Marrow Transplant at Medanta-The Medicity Hospital. His clinical focus primarily includes Paediatric Leukaemia and Bone Marrow Transplantation and aims to make Bone Marrow Transplant an available and affordable treatment option to all those who need it. 

Dr. Yadav states that cancer rates are much higher in countries that have industrialised. Based on the data from a SEER review, around 90% of children suffering from childhood cancers get cured and go on to live healthy lives in the US. However, that is not the case in India where almost 30% of childhood cancers go undiagnosed leading to death. Out of the 70% of the diagnosed cancers, around 50-55% obtain and complete the required treatment whereas 20% of the cases drop out of treatment. The survival rate is still 25% and these discrepancies could be attributed to the following reasons:

  1. Limited to negligible funding for childhood cancer research
  2. Limited financial access and/or insurance coverage as cancer treatments are expensive.
  3. Lack of facilities to treat children with cancer 
  4. Lesser scanning equipment like MRI and PET machines to quickly detect the cancers
  5. No specific focus on training medical professionals to treat childhood cancers as most of them are trained to treat other emerging infectious disorders
  6. Around 90% of the cases dropout of treatment within the first four weeks of diagnosis either due to misinformation or fears and doubts. Most of the dropouts also end up seeking other forms of treatment which may not work. 
  7. Some cancers like Acute Myeloid Leukaemia need aggressive chemotherapy that can reduce the white blood cell and platelet count making the patient susceptible to infections and bleeding. Proper hospital monitoring, insurance coverage and consistent care is needed to tackle such treatment-related toxicity or infection. 
  8. There is no uniform and appropriate protocol that is followed in India to treat childhood cancers.
  9. The fear of relapse prevents further treatment as many professionals consider relapse as a death sentence.  

Common Childhood Cancers

  1. Leukaemia

Leukaemia is characterised by high white blood cell count with or without anaemia, thrombocytopenia (lesser platelet count), sometimes leucopenia, progressive pallor (looking extremely pale) and joint pain. The child may also have a testicular mass or orbital eye sarcoma. Leukaemia can either be acute, which is extremely fatal, or chronic which takes months to years to develop. It is important to note that while arthralgia and rheumatic symptoms can be the sole presentation of Leukaemia, it should be confused for just arthritis. 

2. Lymphoma

This cancer normally presents with a mass in the neck or the chest due to swelling of the lymph nodes. This mass may put pressure on the mediastinum, the trachea or the circulatory vessels in the respiratory region making it hard for the child to breathe. For this reason alone, Lymphoma should not be confused for Tuberculosis. The mass may also cause intestinal obstruction. The most common type of lymphoma is Hodgkin’s lymphoma which is said to be caused by the Epstein Barr virus. In Hodgkin’s lymphoma, the patient has owl-shaped eyes and bony lesions. 

3. Neuroblastoma

Neuroblastoma usually occurs in infants less than a year old and is a common type of extracranial tumours which is hereditary in nature. The head scan of patients suffering from this cancer will show calcification in the brain. This cancer may also present as retinoblastoma. A PET CT scan can easily detect this type of cancer and can be treated via a laminectomy surgery followed by chemotherapy. 

4. Liver tumours or hepatoblastoma

Liver cancer is usually seen in infants and young children. The specialist should check for Alpha-fetoprotein (AFP) levels as this protein is significantly elevated for this cancer.

5. Rhabdomyosarcoma

These are tumours of the muscle that is seen in the head, neck or extremities. It can also present as a mass in the orbital, nasopharyngeal and middle ear regions.

6. Brain tumours

Brain tumours are extremely complex and require multi-speciality care. Neurosurgeons, radiologists, oncologists and paediatric surgeons have to be actively involved in such tumours. Brain tumour can also appear as astrocytoma, medulloblastoma or spinal ependymoma. 

Dr. Yadav says that since childhood cancers are highly curable, it is necessary to spread awareness to encourage early detection and diagnosis as it can save many lives. He does have hope as more medical professionals are being trained to manage childhood cancers and the availability of upcoming insurance options like the Ayushman Bharat Scheme will be able to cover the costs surrounding these deadly disorders and save a child’s life. 

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