Cancers among young children was the focal point of discussion four days ago when paediatric oncologists came together to discuss various ways of improving the survival rates and quality of life of children with cancer.
While more cases are now being detected due to better following awareness programs conducted by the health care staff of Ministry of Health and availability of diagnostic facilities, there are still pockets of the community who continue to delay bringing their children for examination due to their wrong beliefs that child cancers cannot be cured
Consultant Community Physician NCCP Dr. Suraj Perera debunks these myths as he discusses the different forms of childhood cancers commonly found in Sri Lanka and why it is important to seek immediate medical advice from a qualified Consultant Oncologist to enable children with early symptoms to obtain optimal quality treatment with successful outcomes, in his interview with the Sunday Observer.
Excerpts:
 Dr. Suraj Perera |
Q. Paediatric Cancer which was once considered comparatively rare in the past has shown in recent years that the burden of childhood cancer is growing with both global and local figures rising.
What is Paediatric Cancer? And why is there an increase of this type of cancer at present?
A. Cancers detected from birth up to completion of 19 years (0-19) are considered as ‘Paediatric Cancers’. Therefore, it includes cancers diagnosed in childhood and adolescence.
Over the years there is a marginal increasing trend of paediatric cancers due to early diagnosis with the expansion of health services and diagnostic facilities.
Q. A recent WHO report has stated that cancer is a leading cause of death for children and adolescents, particularly in high-income countries and that the likelihood of surviving a diagnosis of childhood cancer depends on the country in which the child lives. For example in high-income countries, more than 80 percent of children with cancer are cured, but in many low and middle income countries only 15-45 percent are cured. Do you agree?
A. In high income countries since most of the communicable disease related deaths are reduced during the paediatric age groups, proportion of cancer related deaths are higher among paediatric age groups.
Q. What about Sri Lanka?
A. Where Sri Lanka is considered, it is assumed that survival rate is better than the neighbouring countries as it is above 60 percent.
Q. The Report further adds that the reasons for lower survival rates include: delay in diagnosis and advanced disease, an inability to obtain an accurate diagnosis, inaccessible therapy, abandonment of treatment, death from toxicity and side effects, and avoidable relapse. Your comments?
A. Yes those are the key factors for poor survival
Q. What age group is most at risk? Newborn children? Between 1-5 yrs? or Pre-teens?
A. Compared to adults, cancers in childhood are rare. When 5 year age groups of childhood and adolescence (0-4,5-9,10-14, 15-19) are considered, higher incidences of cancers are reported in the 0-4 age period and 15-19 age period. When above age categories are considered relatively higher risk will be 1-5 years.
Q. What kind of cancer is commonest among each of these age groups? I was told it was leukemia. Is this correct? If so, what is the approximate percentage of children with this condition in Sri Lanka? .
A. Yes leukaemia is the commonest cancer in children. In 2020 among males and females in Sri Lanka about 283 leukaemia patients (Male- 166., Female -117) were reported to Sri Lanka National Cancer Registry.
Q. So what is the commonest age group for children to develop this?
A. Leukaemia - 0-4 age group
Q. Is it curable if medication is given at the right time ?
A. Yes. Most of the leukemias can be treated successfully and cured.
Q. What are the other forms of cancer that children suffer from?
A. Bone cancers, Lymphomas (cancer of the lymph nodes), brain tumours.
Q. I read that nerve tumours also occur during early years of life, while bone tumors and muscle tumours are also common in the age group of 05 -09 years of age. Is this true?
A. Yes those paediatric cancers are identified among those age groups.
Q. What about brain tumors that occur in the same age group?
A. Yes
Q. How are these cancers detected ? Scans? Blood tests?
A. According to the type of cancer, the method of diagnosis may vary. Paediatric cancers can be broadly divided into Solid and Blood cancers. Blood cancers are diagnosed with blood tests, bone marrow biopsies and advanced immunohistochemistry tests which will help to confirm as well as to stage the disease.
For solid tumours UltraSound Scans, CT Scans, MRI Scans and histological biopsies are helpful in diagnosis of cancers. PET Scan is a whole body scan which will be helpful for advanced scan. This facility is available at Apeksha Hospital too.
Q. Which of the methods you just mentioned can be considered most effective and the safest to use for children? According to cancer researchers it is a biopsy. What is a biopsy?
A. A Biopsy is taking a tissue sample to be checked in a pathology lab. However, as mentioned earlier, methods of diagnosis vary according to the cancer type.
Q. Are there side effects when using these detection methods on young children? If so, what are they?
A. There are minimal side effects since trained staff is involved in taking biopsies.
However, some may experience pain at biopsy sites and mild risk of bleeding. Local site infection is another possibility.
Q. What are the treatment options? Chemotherapy? Surgery?
A. As the method of diagnosis differs according to the type of cancer, the method of treatment will also differ according to the type of cancer. However, the main method of treatment for blood cancer may be chemotherapy while for solid tumours it may be surgery.
Q. Are these treatment facilities available to all Lankan children with cancer?
A. Yes, most of the treatment options are available at Apeksha Hospital which has a dedicated Department for Paediatric Cancers.
If surgery is required most of the time they are performed by Paediatric surgeons and surgeons of surgical subspecialties like neurosurgery, orthopedic surgery, ophthalmological surgery and ENT Surgery.
Q. Can they be obtained free by parents/guardians on a low cost budget? If so, where and which hospitals?
A. Treatment is free from the point of delivery.
Q. What happens if a child with symptoms of cancer is brought in for examination later than he should have due to various reasons ?
A. He/she will have to undergo investigation at the earliest possible time before we decide on the next procedure. However, delay of presentation may affect the prognosis of the disease.
Q. Is it possible to reverse or control the further progress of the disease of a child already afflicted with cancer?
A. With treatment most of the childhood cancers can be successfully dealt with and the further progress of the disease can be controlled.
Q. What are the symptoms of children who have reached the most advanced stages of cancer?
A. In the advanced stages existing symptoms of each cancer are aggravated and child may experience severe pain and severe fatigue, breathlessness, disturbance of sleep.
However, I wish to reiterate this important message to parents. Don’t wait till the symptoms advance.
Be aware about early warning symptoms of childhood cancers and seek medical advice without delay.. Below are some of the key symptoms on Child Cancer listed for their benefit which they should look out for in order to give their children a better chance for quicker recovery:
* 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
* Eye or vision changes which occur suddenly and persists
* Recurrent fevers of unknown origin
Q. I understand that Palliative Care is available to children with advanced cancer. What is palliative care?
A. Palliative care for children with cancer can be defined as the active total care of the child’s body, mind and spirit. Generally palliative care begins when the childhood cancer is diagnosed, and continues regardless of whether or not a child receives treatment to cure the cancer.
Q. Is this also available to the distraught parents?
A. Yes palliative care is addressing not only the affected child but also supports other children of the family and their parents as well.
Q. Ideally a young child hospitalised with cancer needs his/her parents close to him all day and night for assurance and comfort. So are there separate wards or rooms in our government hospitals where these children can be hosed along with their parents?
A. Majority of childhood cancers are treated at the Paediatric Oncology Wards at the Apeksha hospital. With the paediatric cancer patients one of their parents can stay.
Q. Now that we are fast moving into a hi-tech age, what benefits have these technologies brought to especially Sri Lankan patients by way of improving their overall quality of life and increasing their chances of survival?
A. One of the main benefits of hi-technology is the reduced time for diagnosing cancers.
Q. Due to its complex nature, cancer is often a health issue that has led to many myths and wrong beliefs. What are some of the myths that are common in Sri Lanka? And how would you like to debunk them?
A. One of the common myths is that paediatric cancers are contagious and cannot be cured which as I have repeatedly mentioned above is untrue as most childhood cancers can be cured with early and proper treatment.
I believe that educating the public on this via the health education approach can go a long way in eliminating this myth.
Q. Sri Lanka is still in the grip of an ongoing Covid-19 pandemic and likelihood of other diseases entering the country. How vulnerable are cancer patients, especially children to such diseases?
A. Paediatric cancer patients are a vulnerable group for Covid-19 pandemic and other disease entities.
Q. So has the Health Ministry and NCCP provided any precautionary interventions to protect them from such diseases?
A. Yes. All infection control measures are followed and vaccination was given to the identified age cohorts.
Q. The WHO has set a deadline of giving all children with cancer across the world quality care with optimal benefits by the year 2030. Do you think this is a realistic goal considering the severe economic crisis we are undergoing right now, shortages of doctors and the general exodus of qualified doctors due to pay cuts and rising living costs?
A. Those challenges could be overcome with active participation of all stakeholders
Q. Do you see any gaps in the delivery of quality care for children with cancer at present in our health system? If so, how would you like to see them filled?
A. There should be good coordination within the health sector and other stakeholders to overcome barriers of paediatric cancer care
Q. What do they need urgently right now to extend their survival rates and give them optimal benefits using available resources?
A. Support for provision of essential chemotherapy drugs without stockout situations
Q. Do you have some guidelines for parents and guardians of children with cancer to follow?
A. Yes. There is a Caregiver booklet for Childhood cancer patients available to anyone.
Q. What is your advice to all parents and guardians of young cancer victims
A. Complete the treatment as advised by the treating Consultant Paediatric Oncologist and attend all follow up sessions.
Follow all the instructions given by the Oncology team while the affected young cancer victim is at home setting.
If any further details are needed always contact the oncology team.
Q. Do you have a contact number for parents of children with cancer to reach easily at any time of the day?
A. Any further details can be obtained, by contacting the Information Centre of National Cancer Institute (Apeksha Hospital), Maharagama on 0112 850 252 extension 1200.