Warriors and Survivors-19

 

Children Cancer Stories by Rukh Yusuf - Blog # 19

 
 

I am Rukh Yusuf, Clinical Pharmacist, also specialized in Total Parenteral Nutrition and Bone Marrow Transplant. I have been working in Pediatric Oncology unit of a public hospital for several years. The mission of this blog is to bring to you the real-life stories of child patients suffering from cancer. Cancer is still a difficult disease to handle and treat. However, when it strikes the children, some so young that they cannot even speak, their agony is beyond expression and words. Let us pray especially for children suffering from cancer for early and complete remission. May Allah shower His Merciful Blessings upon them. Aameen.

Pediatric Cancer Occurrence and Pediatric Oncology Centers in Pakistan -2

Continued from Previous……

Despite the braveness of our warriors and survivors and suffering and efforts of them and their families along with dedication of oncology health care staff, survival rate of children with cancer is still below 50% . In today’s and upcoming blogs we shall see what are challenges and their possible solution for the treatment of these brave hearts and how can pediatric oncology survival rate be improved.

Pediatric Hematology Oncology subspecialty has developed recently in the last few decades in Pakistan and being a low middle-income country there are challenges in the management of these patients. Major challenges include less treatment centers, poor access, and delayed presentation to the specialized centers. Insufficient health care facilities, and lack of public awareness. Illiteracy, poverty, and malnutrition and lack of trained human resources are some other challenges.

In Pakistan, there is no nation-wide cancer data, therefore, it is difficult to find the actual number of children suffering from cancer. With the available data, it is estimated that approximately 10,000 children under the age of 18 years are diagnosed with cancer annually in Pakistan. Out of those 10,000 cases, only about half reach a pediatric oncology unit for treatment. At present, there are only 14 centers for pediatric cancer care in the country.

In Lahore, Children Hospital has dedicated, 100 beds pediatric oncology unit that receives almost 1500 new cancer cases every year (details of cancer types have been discussed earlier). Mayo Hospital and Lahore General Hospital, Lahore treat 100 to 150 patients each annually. Shaukat Khanum Hospital treats almost 400 to 500 patients annually. In Rawalpindi, CMH also treats 250 to 300 new patients per year. Children’s Hospitals Faisalabad and Multan have smaller oncology units and treat almost 100 to 200 new cancer patients each per annum.  Nuclear medicine radiology and oncology institute receive 500 pediatric oncology new cases each year.

Indus hospital has the biggest pediatric oncology unit In Sindh, and they treat around one thousand children with newly diagnosed cancer per annum. NICH treats 500 and Agha Khan treats 300 new pediatric oncology patients annually. There is no dedicated childhood cancer treatment center in interior Sindh and Baluchistan.

With only 14 pediatric oncology centers for a population of over 220 million, out of which children (0-14 years) contribute to around `36 %. The survival rate for childhood cancer in Pakistan is very disheartening i.e. between 35 to 40% while in the developed world 80% of children with cancer survive.

Although fourteen pediatric oncology centers are present countrywide, but their distribution is not uniform. Most of oncology patients come from peripheries, more from northern areas and peripheral areas of Punjab.

Due to lack of specialized centers and healthcare staff in peripheries, a large number of pediatric hematology oncology patients cannot show up for their in-time diagnosis and treatment. More than sixty percent of patients belong to middle and lower middle class. Cancer treatment is costly and of longer duration. If somehow, they are referred to these specialized centers and their treatment is initiated after diagnosis, it is not confirmed that they will complete treatment and will always show up for their scheduled chemotherapies or interventions. Travelling out station for their scheduled treatment is not easy especially when outstation visits are frequent and recurrent.

Many times, these patients cannot come up to oncology centers due to financial issues, their engagement in any other family matters or any other social factors. Pediatric hematology oncology patients demand holistic care and might get affected tremendously due to lack of centers and trained staff. The delay in diagnosis and later breach in treatment and provision of suboptimal care may lead to devastating long-term effects in the form of poor response to treatment or disease relapse.

Due to lack of centers and sub optimal treatment facilities the survival rate for childhood cancer in Pakistan is between 20 to 25% as compared to developed world i.e., 80%. As mentioned earlier. Increase in dedicated pediatric oncology centers, early diagnosis and right treatment can lead to a better survival rate. Pakistan plans to achieve 75% childhood cancer survival by 2030.