Treatment challenges

September 18, 2022

Early detection and timely management can reduce the risk of mortality in childhood cancers

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eptember is childhood (paediatric) cancer awareness month. Every year around 400,000 children and adolescents are diagnosed with cancer (WHO, 2021). A high proportion of them lives in low-middle-income countries (LMICs), where early diagnosis, referral and timely management are not readily available. Lack of cancer screening and poor or no access to wide-ranging cancer treatments has led to disturbingly high prevalence and mortality rates.

Concurrently, the cure rate and prognosis remain abysmal. This can make children suffer long-term side effects and experience discrimination. Cancer and its treatment affect them both emotionally and developmentally. The long-term side effects of cancer may include anxiety, depression and the fear of recurrance. Some children develop a fear of healthcare because of previous experience which can also affect their health as an adult. Reproductive and sexual development problems including infertility can develop after certain cancer treatments. Radiation to brain and some chemotherapy can be a potential cause of learning and memory problems in adult life.

Cancer survivors have a higher risk of developing another cancer. Cancer treatments like radiation therapy and some types of chemotherapy increase their risk of developing second cancers. The commonest ones include skin, breast, and thyroid cancers.

In LMICs only about 20–30 per cent of children survive, compared to more than 80 per cent in high-income countries. This inequity makes it difficult to achieve sustainable development and universal health coverage goals.

Sixty four per cent of Pakistanis are under 30 years of age. Diseases and death in the younger population due to cancer or other diseases impact the country’s economy and adversely affect sustainable development. The adult population is faced with issues like unhealthy diet (including food adulteration), lack of physical activity, raised body mass index (BMI), smoking and alcohol use along with infections like hepatitis B and human papilloma virus (HPV). All of these have a role in carcinogenesis. Modification in these can help reduce risk of cancers in adults. Bearing this in mind, community-based physicians can empower their communities and bring significant change.

Common childhood cancers include: leukaemia (affecting white blood cells), lymphoma involving the lymphatic system, brain and spinal cord tumours, Wilm’s tumour (affects kidneys), and retinoblastoma (eye cancer). But what causes cancers in children?

In LMICs only about 20–30 per cent of children survive, compared to more than 80 per cent in high-income countries. This inequity makes it difficult to achieve sustainable development goals and universal health coverage.

In children, the leading cause of cancer is inheriting faulty genes. With a high rate of consanguineous marriages, risk of certain cancers like leukaemia increase. Hence early detection and prompt referral is key. Late presentation or reporting is associated with bad outcomes.

In LMICs only about 20–30 per cent of children survive, compared to more than 80 per cent in high-income countries. This inequity makes it difficult to achieve sustainable development goals and universal health coverage.

We need to take swift action as every child with cancer deserves good care. Governments across the globe have started taking steps to prioritise action on childhood cancer after World Health Assembly Resolutions. The WHO Global Initiative for Childhood Cancer was launched in September 2018. A clear target has been set. However, more must be done to improve the survival from childhood cancers in LMIC.

Screening for childhood cancers is usually not recommended. Parents and doctors can identify unusual clinical signs and symptoms provided education of masses and training of primary care physicians takes place. This brings us to questions like how effective is the identification of common paediatric cancers by primary care physicians working in LMICs; or what trainings either run-through or as part of continuous professional developments (CPDs) are offered to primary care physicians in suspecting or diagnosing paediatric cancers? Early recognition and referral will no doubt increase the chances of a cure and reduce the mortality from childhood cancers.

Meeting a challenging situation like this in a weak healthcare system with no structured primary care set-up is a daunting task. Children with these illnesses are often unable to access care. There is a general lack of cancer treatment centres. Financial hardship is one of its major causes, as most families cannot afford cancer treatment.

There is reliance on non-governmental organisation to have expensive cancer treatments that are not accessible to every citizen.

Including cancer treatment in Sehat Sahulat programme has brought some hope for those who cannot afford treatment. However, there are not many established childhood cancer treatment centres in most public hospitals.

The state of affairs demands immediate attention and prompt measures. In order to bring transition in the current pattern of disease identification and treatment, education of parents, particularly those belonging to high risk families, must take priority. With the growing burden of non-communicable diseases including cancers establishing national cancer database/ registry is imperative. Improving survival rates through early detection and improving access to the healthcare system, including ensuring adequate funding for the affected families, particularly in low-income communities, must be enacted.


Dr Hina Jawaid is an assistant professor in family medicine at the University of Health Sciences, Lahore

Dr Abdul Jalil Khan is an assistant professor in family medicine at Khyber Medical University, Peshawar



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