According to WHO, the most common type of childhood cancer is leukemia and around 35 to 40 per cent of the cases are treated for the same
By Dr Stalin Ramprakash
Cancer being one of the leading disease-related causes of death, in a highly populated developing country like India where there is significant lag in cancer outcomes compared to our developed counterparts, we need to acknowledge these children and their families who are dealing with a cancer diagnosis. And the month of September, commemorated as the Childhood Cancer Awareness Month, gives us this opportunity. But one of the greatest obstacles there lies is the lack of awareness and the late detection of the disease which brings down the survival rate. The coronavirus triggered lockdown made it all the more challenging to deliver the regular treatment procedures and there is even more delay in seeking medical attention, inevitably leading to significant diagnostic delays.
According to a Lancet report, every one out of two children with cancer dies undiagnosed and untreated. While experts state that childhood cancer, which is mostly curable, comprises almost 3-5 percent of the total cancer cases in India, there is a lack of data on various factors which brings down the cure rate. Thus, we need to raise awareness about the reality of childhood cancer and emphasise on the importance of research in identifying and addressing correctable factors. If diagnosed early, almost 75-90 per cent cases of cancer among children can be treated successfully.
In light of COVID-19 pandemic, reassessment of childhood cancer care is a must. The pandemic besides delaying the diagnoses and treatments in children, it has also increased the chances of relapse among children with cancer as follow ups are compromised. Their weak immune system has made them more vulnerable to the virus and hence needs extra care and focus. The pandemic has also encouraged insufficient funds and late detection of the disease. Some of the major challenges were to procure medicines and access specialized tests while essential treatments, including chemotherapy, immunotherapy, surgery, and radiation therapy, were delayed. And the most difficult part was to find admission in the hospitals on them being designated as the Covid-19 facilities.
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As childhood cancer behaves differently from what it does in adults, the therapy is always tailored to the child and all this requires a super-specialist who is trained only for the very purpose of treating children with cancer. Childhood cancers are generally aggressive and need intensive treatment but have a much higher success rate than adult cancers. The crux of success in treating childhood cancers is in early detection of symptoms, accurate diagnosis, employing the right treatment protocols and procedures, providing high standard supportive care and anticipating and managing any complications that may arise. The COVID-19 led pandemic has interfered in many of these treatment processes. Childhood cancer treatment has to proceed without delay in majority of the occasions in order to save the patient’s life. COVID-19 generally causes milder illness in children compared to older adults. Though there may be some amount of risk, but the fear of COVID-19 should not compromise on the cancer care, that might be even more dangerous for the patient.
With the advancement in cancer cure over the past few decades, it is possible to treat nearly 70-80 percent of all childhood cancers globally. And by awareness on the issue, improving access to care, promoting widespread insurance coverage in India, where the survival rate is lower than other developed countries can be edged forward to achieve the maximal curability among children.
Financially crippled by the high cost of treating paediatric cancers, effects of the pandemic and the lockdown have been catastrophic, there has been a severe challenge to raise funds through crowdfunding, a scarcity of organ donors and the blood banks had run dry while there was no scope for medical travels with the extended lockdown.
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The time calls for an infrastructural change, increase in manpower and other resources such as hospital beds so that nobody who has a life-threatening emergency during this time goes without access to treatment.
What causes childhood cancer?
Mostly, the cause of childhood cancer is not known in any given individual, but we know that cancer arises due to damage and mistakes that accumulate in the DNA. Whereas nowadays, the lifestyle plays a pivotal role in our overall health. Some of the shifts in our lifestyle with easily available packed or junk foods, less of physical activities, prolonged sitting, obesity, drinking too much alcohol, or cigarette smoking, environmental pollution are exposing adults to increased risk of cancer but these factors don’t affect much in childhood cancer. Few studies and past researches have proved that smoking in front of your children does affect their health and might increase the risk of generating cancer in them. Also, environmental factors like radiation exposure, too much exposure to pollution, or environmental disasters like the Bhopal gas tragedy have been linked to some childhood cancers. Very rarely strong family history of cancer may be suggestive and could also predispose the future generations to increased risk of cancer due to the inheritance of some faulty genes.
According to WHO, the most common type of childhood cancer is leukemia and around 35 to 40 per cent of the cases are treated for the same. While the other most common types of cancer among children include brain tumors, lymphoma, childhood kidney tumors, tumors arising from left over primitive cells like neuroblastoma and retinoblastoma which is a type of eye cancer.
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What are the symptoms of childhood cancer?
Unexplained fever lasting for more than three weeks.
Bone pains or joint pains where an explanation has not been found.
Bleeding under the skin, gum bleeding or bleeds from the nose.
Not able to urinate, or blood discharge during urination.
Unexplained lump, firmness or swelling anywhere in the body and is increasing in size.
Persistent headaches, abdominal or back pain that does not go away.
Persistent vomiting which is unexplained.
Sudden unexplained seizures or change of behaviour or gait disturbance.
New onset of squint or double vision or head tilt.
Feeling short of breath or breathing heftily
Frequent infections or flu-like symptoms.
Feeling tired and fatigue and facing unexplained weight loss.
Blurring or dimming of vision.
How can parents cope with it?
In spite of experience, it is challenging to break the news to the parents that their child has cancer and then to counsel them about the disease, its natural course, its long, arduous, grueling, and heart-wrenching therapy, and the dreaded possibility of relapse in the body. There is a lot of hand-holding that is required when children are treated with cancer, particularly for families from the lower socio-economic strata. Patients and their family could use telemedicine in these trying pandemic times to get connected with the right experts, which can also be referred later to focus on prevention and treatment of late effects and ongoing follow ups post the treatment.
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Parents dealing with recurrent cancer in their children often experience emotions such as disbelief or fear. They even undergo depression or sadness with certain physical changes like trouble sleeping, difficulty with concentrating, changes in appetite, or feeling a constant anxiety in them. They are suggested to talk with the health care professional about these feelings and ask about support services to help with coping. The silver lining is the satisfaction of curing a child out of cancer and the happiness in the voice of the parents once they are through the ordeal.
What can be the precautionary measures for the cancer children with the ongoing pandemic?
Risk of exposure to SARS-CoV-2, either in the hospital or community setting, has resulted in widespread anxiety among families of children with cancer. According to the standard guidelines, families should emphasise on the basic respiratory hygiene and avoid on the sick contact to reduce the risk of transmission among children.
Social distancing is recommended to limit potential exposure. On the part of the hospital, the number of people visiting oncology departments should be minimised by limiting the visitor numbers and the use of telehealth for non-critical outpatients should be encouraged so that the children in follow-up or survivorship clinics, who require hospital visits can be protected.
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To conclude, we must know the risks to our children and think of our responsibilities of preventing them because our children are the hope of our future and of our country. While cancer treatment for children has a high success rate, delays in diagnosis, high medical expenses, lack of universal high quality health care or health insurance, limited access to cancer care centers and abandonment of treatment at diagnosis or during treatment are significant reasons why four out of five Indian children do not survive cancer, according to experts. There are many success stories of childhood cancers in our country as well. Not letting the spirit die, we can surely be able to cure childhood cancer at a much more rapid pace giving our best chance of success for every single child diagnosed with cancer.
(The writer is Consultant – Paediatric Haematology, Oncology and BMT-Aster CMI Hospital)
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