Childhood cancer has leaped in recent years with the number of cases surging on a daily basis both in Sri Lanka and across the world. The Sunday Observer asked Consultant Community Cancer Physician of the National Cancer Control Program Dr Suraj Perera to give us more insights into this worrying health issue.
Excerpts.
 Dr. Suraj Perera |
Q. What do you mean by childhood cancer?
A. Cancers detected from birth up to completion of 19 years (0-19) are considered as ‘Childhood Cancers’. To give the emphasis that adolescent age groups are also included, it is also named as ‘Childhood and Adolescent Cancers’.
Q. What is the significance of this day?
A. The objective of commemorating this day is raising awareness about childhood and adolescent cancers and to express support to children and adolescents with cancers, the survivors, family members, health and non-health care givers.
The concept of commemoration of International Childhood Cancer day was introduced in 2001 by ‘Childhood Cancer International’(CCI), the umbrella patient support organization of childhood cancers comprising parenting organizations, childhood cancer survivor groups, the number of cancer societies and other civil society organizations.
The first International Childhood Cancer day was commemorated in 2002.
This year is the second year of a three-year campaign (2022-2023) under the theme of ‘Better survival is achievable’. For each year an extended theme is introduced to the main theme to further concentrate on needed action.
This year it highlights the importance of health care professionals’ active participation and their impact on the lives of children and adolescents with cancer. It re-emphasizes the importance of “Right care at the right time by the right team”
Also, special tribute is paid to the health care teams and their contribution to childhood cancer care from prevention, early detection, diagnosis, treatment, survivorship and palliative care.
Also the theme is aligned with World Health Organization’s ‘Global Initiative for Childhood Cancer’ with ‘Cure All’ strategy.
Q. What is the burden of childhood and adolescent cancers in the world?
A. Even though the burden of childhood cancers is relatively less than adult cancers, there is a rising trend in cancers among children and adolescents too.
Globally about 400,000 cancers are reported per year among children and adolescents.
When we consider mortality, childhood cancer has become one of the leading causes of death among children globally especially among developing countries. The survival (cure) of childhood cancers depends on the countries they live in. In high-income countries more than 80 percent of children with cancer survive, but in many low and middle-income countries (LMICs) only about 20 percent survive.
Q. How about the situation in Sri Lanka?
A. Yearly about 800-900 cancers are reported among children and adolescents in Sri Lanka according to the National Cancer Registry and Childhood Cancer Registry published by the National Cancer Control Program of Ministry of Health Sri Lanka.
In 2019, 402 males and 378 females were diagnosed having childhood or adolescent cancers giving 1 to 1 male to female ratio of incidence of childhood cancers.
Overall cause specific death data was published by the Registrar General department is available upto 2014 only. During the 2010-2014 time period, the total number of childhood cancer deaths in Sri Lanka was considered, on average about 263 deaths per year. Overall male: female ratio of mortality of childhood cancer was nearly 1.2:1.
Q. What are the common childhood cancers in Sri Lanka?
A. Common childhood cancers are Leukaemias (blood cancer), bone cancers, Lymphomas (cancer of the lymph nodes) and brain tumours.
The highest number of deaths due to childhood cancers occurred due to Leukemias and Brain tumours.
Q. How can we prevent childhood cancers?
A. The origin of childhood cancers is generally unknown and unrelated to the lifestyle. There are unknown causes for most of the childhood cancers and most are not inherited too. Therefore childhood cancers cannot be prevented or screened.
Q. What are the common symptoms of childhood and adolescent cancers ?
A. Every parent needs to be aware of early warning symptoms of childhood cancers and need to get medical advice if any similar symptom/s is/are appearing among his or her loved ones.
Some of the key symptoms are listed here and those symptoms have a pneumonic called ‘CHILD CANCER’
* Continued, unexplained weight loss
* Headaches with vomiting during early night or early morning
* Increased swelling or pain in bones, joints and legs
* Lump or mass in abdomen, chest, pelvis or armpit
* Development of excessive, bleeding, bruising or rash
* Constant Infection
* A whitish colour behind the pupil
* Nausea which persists or vomiting without nausea
* Constant tiredness or noticeable paleness
* Vision changes which occur suddenly and persists
* Recurrent fevers of unknown origin
For improving outcomes for children with cancer requires early and accurate diagnosis followed by effective treatment for symptoms suggestive of childhood cancers.
Q. Can you explain the treatment options?
A. Most of the childhood cancers are treated at the Department of Paediatric Oncology of the National Cancer Institute (Apeksha Hospital) Maharagama. Consultant Paediatric Oncologists or Consultant Oncologists with special interest in paediatric oncology are the team leader of overall management of children with cancers.
If it is a tumour, surgery may be the priority option to excise and remove the bulk of the tumour and Consultant Paediatric Surgeons or any other surgeon of surgical subspecialty will attend to it. For leukaemias it will be chemotherapy and immunotherapy. In some cancers, especially in brain cancer, radiotherapy is also offered as a treatment option.
Q. How about Covid-19 infection and Childhood cancer
A. Invariably Childhood cancer patients are one of the vulnerable groups for Covid-19 infection. Because disease itself as well as mode of treatment may compromise immunity of the cancer patients and may lead to severe Covid -19 infection. Therefore, maximum precautions need to be taken to prevent infecting Covid -19 to the Childhood cancer patients. Therefore, visitors are restricted to childhood cancer patients and caregivers are requested to be with the patient without meeting other family members who are coming from the community.
The Global Registry of Covid-19 in Childhood Cancer: a large multinational study on Covid 19 affected childhood cancer patients revealed that severe disease of Covid -19 infection happens among 20 percent of childhood cancer patients in comparison to 6% of average childhood cancer patients.
According to the instructions of the treating consultants adolescents with cancers need to be given the Covid-19 vaccination at the appropriate time intervals.
Q. How does childhood cancer affect the family of the children with cancer ?
A. Since the entire family is involved with the affected child on his journey of cancer, their health status in all domains may be disturbed. Therefore, it is important to pay attention to their needs too. A study was conducted by a team led by Dr. Sachintha Dilhani recently among childhood cancer caregivers at the Apeksha hospital, it was revealed that almost all caregivers who were at early stages of diagnosis were in high distress and had a lot of unmet psychosocial needs including emotional needs, financial needs and informational needs. Therefore, addressing these needs and safeguarding families of children with cancer from financial ruin and social isolation, should be an integral component of quality cancer care.
Q. Is Sri Lanka ready for meeting the challenge of achieving high cure rates for childhood cancers ?
A. Sri Lanka is selected as one of the focus countries for the Global Initiative for Childhood Cancers. Therefore, Sri Lanka is taking the leadership in strengthening childhood cancer care. Additionally, the National Cancer Control Program (NCCP) with the participation of clinicians, health ministry officials, professional organizations, civil society organisations and Development partners, ‘under the national Plan on Childhood and Adolescent Cancer Care in Sri Lanka 2021-2025’ was launched. This plan is available on line at the NCCP website too www.nccp.health.gov.lk
In addition, Apeksha Hospital Maharagama (National Cancer Institute) became a member of St. Jude Global Alliance for improving quality care for childhood cancers with the knowledge sharing partnership with St. Jude Children Hospital USA and their partner organisations.
Q. What is the role of the Civil Society in childhood cancer care ?
A. Supporting paediatric cancer unit for new constructions, conducting awareness programs and developing communication materials, arranging livelihood programs for the families with a childhood cancer patient, financial support for investigations outside the hospital, financial support for buying medicines are some of the activities conducted by different Civil Society organisations.
Indira Cancer Care Trust, a leading Non-Government Organisation involved in cancer control activities is building a first Palliative care hospice for childhood cancer patients at a premises closer to the Apeksha Hospital. Lions Clubs throughout the country have identified Paediatric cancer projects as one of their flagship community projects in this year.
Q. Do you have any take home messages for our readers?
A. If there are any suspicious symptoms among children, please take prompt action to obtain medical advice. Consult your family doctor or attend the closest hospital or consult the consultant Paediatrician.
Most of the childhood cancers are curable if prompt treatment is offered as early as possible. Complete course of treatment and regular follow up care is needed for achieving total cure.