paediatric oncologist is a specialist doctor who treats children suffering from cancer. There are only about 30 trained paediatric oncologists in the country. Pakistan is a low-income country where people die of easily curable health conditions like pneumonia and diarrhoea. Therefore, childhood cancer is not a priority and remains a neglected field. Our governments invest more in the prevention and treatment of communicable diseases, which make the greatest disease burden and improvement of primary health care, which does not meet the needs of the common man.

Every year about ten thousand new children are diagnosed with cancer in Pakistan. It is estimated that about 50 percent of children remain undiagnosed and die before they reach childhood cancer treatment centres. The reasons for misdiagnosis are mostly a lack of qualified doctors at the primary level and poor health infrastructure. South Punjab has a population of about 40 million people, and about 1,500 children are diagnosed with cancer in this region every year. There are only 11 tertiary care hospitals for this large population of South Punjab: five in Multan, four in Bahawalpur, one in Rahim Yar Khan and one in Dera Ghazi Khan. There is only one tertiary care children’s hospital located in Multan, which is also the only childhood cancer centre in South Punjab.

The paediatric oncology unit at the Children Hospital Multan has a 40-bed ward which is being run with the support of NGOs. Dr Zulfiqar Ali Rana, a consultant paediatric oncologist and head of the paediatric oncology department, said that they accept every cancer patient who makes their way to the outpatient department or the paediatric oncology emergency room; however, they treat only 300 patients every year. Still, their ward is overburdened and overcrowded. He further said that the survival rate of children with cancer in his unit is only 30 percent, which is much less than the institutes with better supportive care in Lahore and Karachi.

Most childhood cancer patients from South Punjab are taken to Karachi or Lahore for treatment. There is no private sector hospital in South Punjab which can accept these children for treatment. This is because it requires a lot of care and investment. Moreover, very few doctors opt to specialise in this field.

A large number of cancer patients, including children, adolescents and young adults from Khyber Pakhtunkhwa and Balochistan, are referred to cancer centres like the Shaukat Khanum Memorial Cancer Hospital and Research Centre, the Aga Khan University Hospital and other public or private sector childhood cancer hospitals in Lahore and Karachi. Unfortunately, there is not a single comprehensive cancer unit for children in Balochistan, Khyber Pakhtunkhwa and across the border in Afghanistan. There is a small paediatric oncology unit built with a public-private partnership in Quetta, but it is not sufficient for the poor children of Balochistan. A cancer hospital has been built by the Shaukat Khanum Trust in Peshawar. However, it is also not adequate for the province. When I was working in Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore in 2019, more than 40 percent of childhood cancer patients treated over there belonged to either KP or Afghanistan. Similarly, a large proportion of children treated in Karachi centres belong to either Balochistan or Afghanistan. As people from remote areas have to travel to major cities for childhood cancer treatment, they face a number of problems.

Cancer is mostly treated with either chemotherapy or radiotherapy; these treatment modes are very toxic and suppress the body’s immune system. As a result, these children become immunocompromised and more vulnerable to infections. There are many other short-term side effects of treatment such as bone marrow suppression and cardiovascular, renal, neurological and gastrointestinal complications. Some patients need frequent transfusions of blood products and admissions to the emergency room, paediatric ward and intensive care unit. Therefore, the primary paediatric oncologists advise them to stay in the city and do not allow them to travel to their hometowns during active treatment. This causes psychological and social problems for these families. Since most of them belong to lower or working class, it becomes very hard for them to bear the living expenses.

House rents are high, and feeding their children a healthy diet is expensive. Sometimes the family head has to quit their job, making the situation even worse. Many parents abandon treatment due to above mentioned circumstances and return home.

The governments should pay more attention to this neglected field of medicine and build more paediatric oncology centres, especially in South Punjab, Khyber Pakhtunkhwa, interior Sindh and Balochistan. They should also invest more in paediatric oncology in already functional public sector hospitals. More doctors should be encouraged to join the subspecialty of paediatric oncology by increasing their salaries and benefits. Unfortunately, some private trust hospitals in Pakistan exploit these patients to gain more funds. They spend very little of the collected donations on the children, and most of it allegedly goes into their own pockets. This practice should be stopped by monitoring them closely and taking strict action against such malpractice.

Childhood cancer is not just a physical disease, but also a social and psychological burden for families and children. Childhood cancer centres should provide not only chemotherapy and radiotherapy but also psychosocial support to these patients. They should provide them a neat and clean environment to prevent them from frequently becoming ill and dying from common infections. They should spend on accommodation and healthy diets for all those who come for treatment from remote areas.

The Best Care Hospital Multan is the first health card run private sector hospital in the Punjab, which has taken the initiative of building a childhood cancer centre with the help of Sehat Sahulat Programme. Mr Khawar, the zonal head of this programme, Dr Sadia Kazmi, the provincial medical officer and Dr Irfan Akhtar, the executive director of Best Care Hospital have been a tremendous support in starting this project. The hope is that this project will go a long way towards improving childhood cancer care, particularly in the region and in other deprived areas of Pakistan. We are determined to work as a multidisciplinary team to treat our children. We are also heading towards establishing a network of tumour boards not only for childhood cancer but also for the multiprofessional management of adulthood cancers. We have already made a Multan Sarcoma Group for which I am grateful to Dr Badar Zafir, Dr Khalid Chishti and Dr Kamran Siddiqui from the orthopaedic units of the Nishtar Hospital Multan, Dr Ijaz Masood from the medical oncology unit of Nishtar Hospital Multan, Dr Abdul Mateen from MINAR, Dr Abdul Sattar from the department of radiology Nishtar Hospital Multan, Dr Abdul Sami from the department of pathology Nishtar Hospital Multan and Dr Zulfiqar Ali Rana from Children Hospital Multan. I hope that very soon, we will be able to establish tumour boards in Multan for all liquid and solid cancers. We aim to discuss every cancer patient in these tumour boards before the start of their treatment, which is a standard practice.

The writer (MBBS, MCPS Pediatrics, FCPS Pediatrics, Fellowship Pediatric Hematology & Oncology Aga Khan University Hospital Karachi) is a pediatric oncologist currently working as head and project director of Paediatric Oncology at Best Care Hospital Multan