Another Childhood Cancer Awareness Month has come to an end, and doctors say more needs to be done to better manage paediatric cancers. Raising awareness levels, ensuring treatments by specialists, easing access by setting up more centres, making treatments affordable and above all prioritising childhood cancers are the need of the hour.
According to the International Agency for Research on Cancer, World Health Organisation, an estimated 4,00,000 children and adolescents aged 0 to 19 years are diagnosed with cancer per year worldwide.
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In Tamil Nadu, according to R. Swaminathan, professor and head, Department of Epidemiology, Biostatistics and Cancer Registry and associate director, Cancer Institute (WIA), a total of 2,513 new cancers occurred among children in 2022, accounting for 2.9% of cancers in all ages. It occurred in the ratio of 123 boys to 100 girls. The rate of occurrence was 100 per million boys and 80 per million girls. Leukemias, lymphomas, brain and central nervous system were the most common malignancies in children.
Paediatric cancers account for 2-3% of all cancers diagnosed in India. Blood cancers - leukemia - are the most common cancers in children followed by brain tumours, Venkataraman Radhakrishnan, professor, Medical and Paediatric Oncology, Cancer Institute, said.
“Lack of awareness is one of the main challenges in childhood cancers. There are no specific symptoms; fever, headaches, vomiting and abdominal pain are some of the symptoms but these usually mimic common infections, resulting in late diagnosis. People do not know this, as a result children are taken for treatment when the disease has advanced,” he said.
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Paediatric cancer care centres are mostly concentrated in major cities such as Chennai, he said, adding: “We need dedicated paediatric physicians and centres. We also need a dedicated paediatric cancer registry.”
Costs remain high
“The cost of care is increasing rapidly. Bills can go up due to infections and treatments in intensive care units, raising the need for full insurance coverage. For instance, treatment for common blood cancers cost ₹5 to ₹6 lakh but insurance schemes provide a maximum of ₹1-1.5 lakh. We need enhanced packages to provide better insurance coverage for childhood cancers,” Dr. Radhakrishnan said.
Her said India accounts for 18% to 20% of the world’s burden of paediatric cancer cases. “Historically, the Government of India has not prioritised paediatric cancers. Paediatric cancers do not feature in the national cancer control policy. What is needed is a major policy shift by the government, recognising paediatric cancers and including them in the national cancer control policy. Smaller countries such as Peru and Sri Lanka have prioritised childhood cancers. Paediatric cancers should be made a priority for funding research. There needs to be better access to medicines and funding.”
Aruna Rajendran, Haemato Oncologist and Bone Marrow Physician, Madras Medical College and Rajiv Gandhi Government General Hospital, said awareness and diagnosis of childhood cancers have improved. With leukaemia being the major group of cancers in children, she said now, tailored therapy - individual-centric - has enabled a good prognosis of at least 70%. “Relapse accounts for 20%, and relapsed leukaemia, is in fact, turning into another group of cancer in children worldwide,” she added. Under the Chief Minister’s Comprehensive Health Insurance Scheme in Tamil Nadu, coverage of ₹10 to ₹17 lakh is provided for Bone Marrow Transplantation predominantly for relapsed leukaemia,” she said.
There is availability of good supportive therapy now, ensuring good outcomes, she observed. “What is needed is that paediatric cancers should be treated by paediatric oncologists and surgeons, while there is a need for paediatric oncology nurses to provide care,” Dr. Aruna said.
Acute Lymphoblastic Leukaemia needs three years of treatment, including six months of intensive chemotherapy during which the child and family should stay near the facility. The time spent by parents during the course of treatment and the time spent away from school for the child and siblings should be factored in. “Centres closer home will reduce indirect expenses for the family. There should be more shared care paediatric oncology centres,” she said.
Radhakrishnan Satheesan, senior consultant, Paediatric Cancer Management Team - Paediatric Cancer Surgery, Apollo Proton Cancer Centre, said awareness of paediatric cancers was certainly increasing, but more in the urban setting. “But we have a long way to go and lots to do,” he said. Primary among them is to establish Public-Private partnerships to evolve a cost-effective formula, as some public sector hospitals are overburdened and many persons cannot afford treatment in private hospitals.
Dealing with solid tumours in children such as in the kidneys, neuroblastomas, and Ewing sarcoma, he said, “A multidisciplinary team-based approach that includes paediatric oncologist, surgeon, pathologist and radiologist is required. Treatment-wise, there has been a monumental change from the 1970s to now.”
In general, when detected early, the five-year survival was nearly 80% to 90%. Each cancer, he said, has its own prognosis. “Paediatric cancers are a huge burden on a family, emotionally, financially and physically. These children will need life-long follow-up,” he added.
Not everybody is able to afford treatment, Dr. Satheesan observed. “The drugs are expensive and there could be significant after-effects of treatment. A good percentage of people cannot afford it. As a result, many are lost to follow-up.” He felt that the cost of treatment should be brought down.
He also raised the need for more awareness not just among the general community but also among primary care providers - paediatricians and family physicians.
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