Every minute, four children worldwide receive a devastating diagnosis: cancer. The statistics are sobering—annually, approximately 4 million children and adolescents aged 0-19 years are afflicted by this ruthless disease. Among the myriad forms of childhood cancers, leukemia, brain tumors, and Wilms tumor stand as the most prevalent.
In high-income countries, where comprehensive services are generally accessible, more than 80% of children with cancer are cured. In low- and middle-income countries (LMICs) like ours, it is estimated that only 30-40% get cured. India is home to at least 20% of the global childhood cancer burden, with nearly 78,000 children and adolescents getting diagnosed with cancer every year according to the World Health Organisation (WHO). A recent National Cancer Registry Programme (NCRP) report in India reveals that childhood cancers in the 0-14 age group account for 4.0% of all cancers diagnosed every year.
Childhood cancers are different than those that are seen in adults. While there are typically risk factors that can be altered to help prevent the risk of cancer in adults, most cases of childhood cancer are sporadic (90-95%) or related to inherited genetic mutations or disorders (only in 5-10%). It is important to know that if a child is diagnosed with cancer, there is typically nothing that could have been done to avoid the diagnosis. Childhood cancer cannot generally be prevented or identified through screening. Unlike the common myth, childhood cancers do not spread from one child to the other.
Most childhood cancers can be cured with cancer directed treatment like chemotherapy, surgery and radiotherapy. Significant strides have been taken in the last decade in developing immunotherapy and cell-based therapy which has also shown promising results. Generally, the side effects of the medicines are tolerated well in children as they do not have underlying co morbidity like diabetes, hypertension etc.
Avoidable deaths from childhood cancers in LMICs result from lack of awareness about the diagnosis of cancer in children, misdiagnosis or delayed diagnosis, obstacles to accessing care, abandonment of treatment, death from toxicity, and relapse. Many families need to travel long distances to access care towards pediatric cancer.
In recent years, India has witnessed a substantial increase in paediatric cancer cases, transforming it into a significant public health concern. This surge in childhood cancer cases in India mirrors a global trend, emphasizing the necessity for a comprehensive understanding of contributing factors. A complex interplay of factors, including environmental pollution, genetic predisposition, and lifestyle changes, has collectively contributed to the alarming rise in cases, presenting challenges for the Indian healthcare system. Paediatric oncology in India faces challenges arising from limited rural healthcare access, resulting in delayed diagnosis and treatment. Socioeconomic factors significantly influence families’ ability to afford and access specialized childhood cancer care with significant out of pocket expenditure which includes cost to stay near the cancer centre, nutrition and transport to and from the cancer centre. Unlike adult cancers like breast and cervical cancers, early detection of cancer in children remains a challenge and is possible only in a few patients who have tumors in the eyes (Retinoblastoma).
Advocacy and awareness campaigns hold particular significance in the Indian context to tackle the multifaceted challenges posed by children with cancer. Grassroot initiatives, supported by both government and non-governmental organizations, play a pivotal role in disseminating accurate information, dispelling myths, and encouraging early intervention. Engaging primary care physcians communities and empowering parents with knowledge about childhood cancer can significantly impact the overall landscape of early diagnosis and treatment.
By Dr Harish Varma T, Assistant Professor, Division of Pediatric Hematology and Oncology, Kasturba Medical College, Manipal and Vasudeva Bhat, M.D. D.M., Professor and Head, Division of Pediatric Hematology and Oncology, Deputy Coordinator, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal
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