Cancer in children constitutes 5.5% of total cancer cases in India according to the Indian Council for Medical Research. This percentage has more than doubled from 2.5% ten years ago. A disturbing reality, however, is that only around one in 10 of the childhood cancer cases receives complete therapy. As a consequence, while cure rates for common childhood cancers like lymphoma and leukaemia are over 80% in the developed world, in India, they have remained abysmally low at around 30%.
The reasons behind these unacceptable statistics are numerous. Childhood cancer, like a number of other public health issues in India, is associated with considerable social stigma. Additionally, there are health system challenges like inadequate access to care and exorbitant treatment costs in the private sector. Treatment is available free of cost in a number of public health facilities but overcrowding and long waiting times makes it very difficult for children to receive timely and quality care. The result is that countless lives are snatched away prematurely and numerous families are destroyed. The direct and indirect costs to society are tremendous .
What needs to be done
There are several aspects of childhood cancer diagnosis and treatment in India that need to be strengthened.
Firstly, diagnosis and treatment services need to be more accessible to families all over the country. Currently, a number of the major cancer hospitals or those that have the requisite facilities are concentrated in big cities. Families who have a child suffering from cancer often need to travel long distances to access treatment. This only compounds the distress and anxiety.
Secondly, a child coping with cancer needs physical, mental and emotional support. Simply putting them on treatment is not enough. Cancer treatment is often very long drawn out and painful with children suffering from a number of side-effects. Efforts therefore have to be made to minimise pain as well as keep children in a positive frame of mind.
Third, even if a child has been fully cured, it is vital that his or her health is monitored closely. This includes regular check-ups as well as nutritional support. In the absence of this, children often suffer from a relapse. They also become susceptible to infections due to weakened immunity which is a consequence of cancer and its arduous treatment. Also, during treatment, most children are unable to go to school and resuming studies after a break of a few months or years is very difficult. Thus, support with education post-treatment can allow childhood cancer survivors to lead productive lives.
Types of cancer in children:
Types of cancer in children are very different from those that occur in adults.
The most common ones are:
- Acute lymphoblastic leukaemia
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
- Wilms’ tumour
- Brain tumours
- Bone tumours
- Ewing’s sarcoma
“Probably, the government and society at large are not considering it a big problem as it is just around 5 percent. We are always campaigning for breast and cervical cancers,” Agarwala said.
“We must remember this 5 percent of cancer is majorly curable if given proper treatment,” he said which is an unfortunate situation.
Talking about awareness and symptoms that parents need to watch out for, he said: “Symptoms are different for different cancers, but children who have cancer have poor growth, poor weight gain and decreased appetite. One must get their children evaluated on seeing these symptoms”.
On International Childhood Cancer Day, the hospital organised a ‘Sit and Draw competition’ with paediatric patients and rewarded the winner.
The Tata Memorial Hospital (TMH) revealed statistics of children suffering from cancer disease in Mumbai to mark International Childhood Cancer Day on February 15th. As per the data, five per cent of patients suffering from different types of cancer are below the age of 18 years. In India, every year, there are 45,000 new cases of cancer patients who are under 18.
The difference between cancer in adults and children is that for the latter it is usually considered to be either controllable or palliable. Most paediatric cancers are considered to be potentially curable,” said Dr S Banawali, Head, Medical Oncology. However, the problem is that often, child patients do not know where to go for treatment and get diagnosed wrongly.
Dr A Puri, Head, Bone and Soft Tissues, said, “Earlier, children who suffered from cancer in the limbs had to be amputated, which severely impacted them psychologically. Now with the help of developed technology the limbs can be saved and only the infected part can be removed. In 80-90 per cent of the cases, we have been successful in saving the limbs.”
There are different kinds of cancer, of which blood cancer is considered to be a potent type as it spreads rapidly in children. Nearly 30% of children with blood cancers require bone marrow transplant. “The cure rate of cancers with bone marrow transplant is 50%. However, factors such as high cost, unavailability of donors, often push patients away from the procedure,” said Dr Naveen Khattry, who heads Tata Memorial Centre’s bone transplant unit. In most rural areas, even doctors are unaware of the proper treatment.
Facts about cancer in children:
1. Childhood cancer is curable if diagnosed early and treated appropriately.
2. It is not infectious and does not spread from one child to the other.
3. It is not usually inherited through the genes.
4. Early diagnosis and prompt treatment are essential for good cure rate.
5. Cancer in children is quite different from that in adults in many ways. Firstly only 3% of all cancers occur in children, and secondly, they are fast growing but also very sensitive to chemotherapy treatment. Cure is a very realistic and practically achievable goal.
6. As the treatment is often long it is very important that extra care is taken at home to ensure treatment discipline and regularity, good hygiene and balanced nutrition.
7. The treatment for cancer is somewhat complicated therefore it is advisable to take treatment in an experienced and specialized pediatric cancer unit.
8. A child after completing treatment for cancer is normal like any other child can go to school and play etc.
9. Although the actual number of children who develop cancer is small, the cure rate is high and the total number of productive life years saved by curing these children is significantly high and therefore the effort in treating them appropriately is all the more worthwhile and fulfilling.
10.Warning Signs of Childhood Cancer
- S: Seek: Medical help early for persistent symptoms
- I: Eye: White spot in the eye, new squint, blindness, bulging eyeball
- L: Lump: Abdomen and pelvis, head and neck, limbs, testes, glands
- U: Unexplained: Fever, loss of weight and appetite, pallor, fatigue, easy bruising or bleeding
- A: Aching: Bones, joints, back and easy fractures
- N: Neurological signs: Change in behaviour, balance, gait and milestones, headache, enlarging head