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Table of Contents
MUSINGS
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 6-7

Pediatric cancers in India: The forgotten disease


1 Department of Medical and Pediatric Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
2 Professor and Associate Dean for Research in the College of Nursing, University of Tennessee College of Health Sciences, Memphis, TN, USA
3 Director of Health Systems and Asia Pacific Regional Programs, St. Jude Children's Research Hospital, Memphis, TN, USA

Date of Submission31-Dec-2020
Date of Decision06-Jan-2021
Date of Acceptance13-Jan-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Venkatraman Radhakrishnan
Department of Medical and Pediatric Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_375_20

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How to cite this article:
Radhakrishnan V, Howard S, Lam C. Pediatric cancers in India: The forgotten disease. Cancer Res Stat Treat 2021;4:6-7

How to cite this URL:
Radhakrishnan V, Howard S, Lam C. Pediatric cancers in India: The forgotten disease. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 18];4:6-7. Available from: https://www.crstonline.com/text.asp?2021/4/1/6/312099



“Doctor sir, please save my son's leg, he is very good at studies and sports,” pleaded Ravi's father with me in the clinic as he held the frail 12-year-old boy in his arms. From a distance, I could see a fungating tumor twice the size of a football arising from Ravi's right leg and immediately I knew that we would have to amputate the leg. I wondered where we had let Ravi down; a nation that was sending satellites to Mars was unable to provide “quality care” to its pediatric patients with cancer.

The answer was crystal clear. India has never had a national childhood cancer policy. The National Cancer Control Program, which started in 1975, has focused on priorities like tobacco cessation and screening and the treatment of cervical and head and neck cancers, which constitute the major cancer burden in India.[1],[2] The infrastructure and manpower were therefore geared to address these problems with a focus on establishing radiotherapy departments and machines.

One million new cancers are diagnosed annually in India, and 3% of these occur in children.[3] These 50,000 new pediatric cancers annually diagnosed in India comprise about 20% of all pediatric cancers in the world.[4] It is presumed that about 60% of the children with newly diagnosed cancers in India will succumb to the disease as opposed to only 10% of the children in the developed countries.[5] How do we improve the quality of care for our patients?

The Institute of Medicine in 2001 defined six major domains for quality health-care, namely efficient, effective, equitable, safe, patient-centered, and timely.[6] [Table 1] analyzes each of these quality domains with regard to pediatric cancers in India.
Table 1: Health Quality Domain Assessment of Pediatric Cancers in India

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India has achieved rapid progress in improving its health indicators as is evident from its improvements in the infant mortality rate from 50 to 29 per 1000 live births and the under-5 mortality rate from 64 to 36 per 1000 live births between 2008 and 2018.[7] This has been achieved through universal vaccination, better perinatal services, and strengthening of primary health care for the management of pneumonia and diarrhea. In the above context, it becomes imperative for the government of India to focus on pediatric cancers as it strides toward the control of infectious diseases and malnutrition.

It is said that a child's place of birth should not determine his or her chance of survival. I would go one step further and say that a child's disease and the access to care for that disease should not determine a child's chance of survival; a child with cancer should receive the same opportunities for care as a child with other illnesses like pneumonia or diarrhea.

My public health specialist friend once asked me, “Why should we focus on childhood cancers when the country is facing bigger public health problems?” I told him that childhood cancers are associated with maximum Disability Associated Life Years (DALY) among all cancers in low- and middle-income countries and are among the top six diseases in children contributing to the burden of DALY and therefore deserve attention.[8]

We need to put in more effort at the level of policy-making to integrate pediatric cancer care into the child health and non-communicable disease agenda, and make it a part of mainstream cancer care in India. The inclusion of pediatric cancers in the broader health priorities of the country will ensure that the primary health-care providers are able to refer children with cancer to the designated cancer centers more seamlessly.

The first step toward improving the outcomes in children with cancer in India would be to define the problem, formulate a policy, and ensure the implementation of the policy. The World Health Organization Global Initiative for Childhood Cancer aims to improve the survival for childhood cancers to 60% by 2030, and there is interest within India in support of this global initiative.[9] We need to ensure that children like Ravi are diagnosed earlier and get high-quality cancer care in India.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
National Cancer Control Program of India. Available from: http://www.nihfw.org/National HealthProgramme/NATIONALCANCERCONTROLPROGRAMME.html. [Last accessed on 2020 Mar 25].  Back to cited text no. 1
    
2.
Shetty R, Mathew RT, Vijayakumar M. Incidence and pattern of distribution of cancer in India: A secondary data analysis from six population-based cancer registries. Cancer Res Stat Treat 2020;3:678-82.  Back to cited text no. 2
  [Full text]  
3.
Globocan 2020 India Fact Sheet. Available from: https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf. [Last accessed on 2021 Feb 10].  Back to cited text no. 3
    
4.
International Incidence of Childhood Cancer. Available from: http://iicc.iarc.fr/results/comparative.php. [Last accessed on 2020 Mar 25].  Back to cited text no. 4
    
5.
Atun R, Bhakta N, Denburg A, Frazier AL, Friedrich P, Gupta S, et al. Sustainable care for children with cancer: A lancet oncology commission. Lancet Oncol 2020;21:e185-e224.  Back to cited text no. 5
    
6.
Wolfe A. Institute of Medicine Report: Crossing the Quality Chasm: A New Health Care System for the 21st Century. Policy Polit Nurs Pract 2001;2:233-5.  Back to cited text no. 6
    
7.
Infant Mortality Rate in India. Available from: https://www.statista.com/statistics/806931/infant-mortality-in-india/. [Last accessed on 2020 Mar 25].  Back to cited text no. 7
    
8.
GBD 2017 Childhood Cancer Collaborators. The global burden of childhood and adolescent cancer in 2017: An analysis of the Global Burden of Disease Study 2017. Lancet Oncol 2019;20:1211-25.  Back to cited text no. 8
    
9.
Global Initiative for Childhood Cancer. Available from: https://www.who.int/cancer/childhood-cancer/en/. [Last accessed on 2020 Mar 25].  Back to cited text no. 9
    



 
 
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