How Early Diagnosis Of Childhood Cancer Can Give A Ray Of Hope To Parents

Cancer diagnosis in a child is often devastating news to a family. Life is never the same for a family with a child with cancer. The bright side of childhood cancers is that "it is curable" with excellent outcomes if diagnosed early and treated appropriately.

Cancers in children

Although childhood cancers are rare and constitute less than 5% of all cancers; it is one of the leading causes of disease-related deaths in children the world-over. Fortunately, the cure rates for most cancers in children are excellent.

Every year nearly 4,00,000 children and adolescents are diagnosed with cancer. In India alone, more than 75,000 new childhood cancers are diagnosed each year.

Cure rates of childhood cancers is close to 90% in high-income countries as compared to 30-40% in resource-limited countries. This means the outcome of a child with cancer depends on the place he/she is being treated. We need to "close the gap in care" especially when it comes to childhood cancers. The major gaps in childhood cancers are:

1. Delay in diagnosis: In most children, there is often a delay of 6-8 weeks from first symptom onset to diagnosis due to lack of awareness and misattribution of symptoms. It has often been observed that the family would have had an average of 3-4 medical consultations prior to reaching the Pediatric Oncologist (child cancer specialist).

2. Lack of robust referral system: The family is often perplexed as to whom to reach out for the care. It is very essential to have a clearly mapped pathway - Family -> Family doctor -> Pediatrician -> Pediatric Oncologist. This ensures not only timely referral to the treatment centre but essentially cuts down on unnecessary health care expenditure.

3. Social and cultural challenges: Social factors like residence being urban/ rural, distance to travel to reach a cancer treatment center, financial loss due to professional absenteeism of the caretaker etc prevent a child from being treated. Cultural beliefs may sometimes jinx the diagnosis of cancer and prohibit a child from reaching the treatment centre

4. Financial hurdles: The commonest apprehension we see in the caretakers is the financial burden the treatment would translate to. However, without massive investments in infrastructure, the provision of childhood cancer treatments can be made largely affordable. Early diagnosis and referral is the best way to reduce the initial expenditure. Reducing the out-of-pocket expenditure apart from the main cancer treatment helps. Constructive/visionary health policies from government/ NGO may facilitate subsidising the overall costs.

5. Abandonment of treatment: Premature abandonment from protocolized treatment hinders survival. Provision of local accommodation during treatment, free nutritional supplementation, and creating temporary employment for caretakers may overcome this issue.

5. Appropriate treatment centre: An expert team consisting of a pediatric oncologist, specialized pediatric nursing, supportive staff including social workers, pediatric intensivist, pediatric surgery along with a child-friendly environment is vital for best outcomes.

6. Access to advanced and innovative therapies: The newer innovative therapies introduced in high income countries often takes a long time to access for our patients. This curtails us sometimes to use advanced therapies which may be more effective and less toxic.

Treatment of any cancer is best if "right care can be provided at the right time with a right team". Children are not miniature adults in terms of cancer.

• Spectrum of Cancers in children is very different from cancers that develop later in life. Most common cancer in children is blood cancer followed by brain tumors and cancers of lymphatic systems (lymphoma).
• They are not the so called "Lifestyle cancers" that we see in adults wherein cancer is linked to lifestyle activities like smoking, alcohol consumption etc
• Children tolerate treatment better than adults and hence complete the therapy on time. This translates to excellent outcomes.
• Children have special requirements during treatment - normal growth and development alongside with treatment of cancers is important. Addressing nutritional needs of a child during cancer is very vital.
• Supportive care during treatment needs trained pediatric staff including specialised child nursing care, pediatric intensivist, child surgeon

(Dr. Vinay Munikoty Venkatesh, Consultant- Paediatric Haematology Oncology and BMT, Manipal Hospitals Yeshwanthpur)

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