Prioritizing childhood cancer management

The CureAll framework of the World Health Organization for Childhood Cancer seeks to achieve the goal of achieving at least 60% survival and to reduce suffering for all children with cancer by 2030. The goal has been based on WHO findings that of about 4 lakh children estimated to develop cancer every year about 80% will survive in high-income countries and only 30% will survive in many low and middle-income countries. Countries like India strengthening childhood cancer care will be crucial to achieve the goal. The Policy brief: A situational analysis of childhood cancer care services in India, 2022 released by the Indian Council of Medical Research (ICMR) – National Centre for Disease Informatics and Research (NCDIR) earlier this month has brought to light yawning gaps in childhood cancer management in the country. The policy brief reveals a worrying situation that four per cent of all cancers in India are among children aged 0-14 years, and these are “physically and cognitively debilitating conditions”. Yet, some of the key highlights of the document tell a depressing story of inadequate childhood cancer care services in the country. Less than half of the public and private tertiary hospitals have a dedicated paediatriconcology department. Availability of specialized manpower is low in public tertiary hospitals; less than half of the hospitals had a paediatric oncologist (48%), paediatric oncosurgeon (14.2%),paediatric intensivist (38.9%), medical oncologist (46.7%), and palliative care physician (37.6%). Nurses trained in paediatric cancer and palliative care were available in less than 50% of the public and private tertiary hospitals, according to ICMR-NCDIR analysis. It also found that less than 50% of the public tertiary hospitals had stocks of all four classes of cancer-treating drugs which speaks volume about the availability of childhood cancer-treating medications. The policy document attributes these challenges to the absence of a dedicated national policy and programme focusing on childhood cancers and states that the current cancer program focuses on adult cancers. It lays emphasis on formulating a childhood cancer policy to enable timely diagnosis, treatment, supportive care, and follow-up through well-defined care pathways. Apart from the central government, state governments prioritizing formulation of childhood cancer policy will go a long way in bridging the gap. Integration of childhood cancer as a part of the national cancer control response, financing mechanism and schemes for childhood cancer treatment, training of general physicians and primary care providers to identify signs and symptoms in children with cancer, which will enable timely referral, expansion of paediatric oncology units, training of physicians and paramedics in paediatric oncology and creating large-scale awareness of childhood cancer for its timely diagnosis, completing treatment, optimal cure rate and healthy survivorship are some of the key policy recommendations mentioned in the policy brief which deserves urgent attention of the government to improve childhood cancer care services in the country. Findings of the National Cancer Registry Programme indicate that cumulative risk of developing cancer has been consistently high in Assam and other north-eastern states. While rise in most cancer incidences in adult population in the region is attributed to lifestyle-related factors such as smoking, alcohol consumption, obesity, over eating processed foods, lack of nutritional diet, inadequate physical activity etc. Various scientific studies indicate that very few childhood cancer cases are related to lifestyle behaviour. The real picture of prevalence of childhood cancer in the region being overshadowed by the adult cancer management cannot be ruled out. A comprehensive survey will not only help policy makers to identify the critical gaps, better understand the rural-urban spread and draw the roadmaps, it will also go a log way in generating awareness among parents in notice early signs and seek timely medical assistance. ICMR-NCDIR report on “Monitoring Survey of Cancer Risk Factors and Health System Response in North Eastern Region of India,2022” brought to light that nearly one-third of cancer patients seek cancer care outside their state and about 26% the patients self-finance their treatment while only 5.85% are covered by health insurance. States in the region addressing these gaps simultaneously with generating awareness on cancer in all age groups require earmarking adequate allocations in State Budgets and building capacity for judicious and timely utilization. Communities, NGOs extending helping hand in spreading awareness on cancer and contributing towards establishment of charitable hospitals can reduce the burden on public hospitals. Public-private partnership can help address infrastructure and training requirements and pooling available human resources to reduce waiting period for childhood cancer patients. According to WHO, childhood cancers can be cured with generic medicines and other forms of treatment, including surgery and radiotherapy, and treatment of childhood cancer can be cost-effective in all income settings. Spreading this information is essential so that parents of childhood cancer survivors are encouraged to continue follow-up care to prevent recurrence and late effect so that they can lead a normal life.