Treatment Challenges | Political economics

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September is Childhood (Pediatric) Cancer Awareness Month. Each year, approximately 400,000 children and adolescents are diagnosed with cancer (WHO, 2021). A high proportion of them live in low- and middle-income countries (LMICs), where early diagnosis, referral and prompt treatment are not readily available. Lack of cancer screening and limited or no access to a wide range of cancer treatments have resulted in extremely high prevalence and mortality rates.

At the same time, the cure rate and prognosis remain abysmal. This can lead to children suffering from long-term side effects and being discriminated against. Cancer and its treatment affect them both emotionally and developmentally. Long-term side effects of cancer can include anxiety, depression, and fear of recurrence. Some children develop a fear of health care from a previous experience that can also affect their health as adults. Problems with reproductive and sexual development, including infertility, can occur after certain cancer treatments. Radiation therapy to the brain and some chemotherapy drugs can be a potential cause of learning and memory problems in adulthood.

Cancer survivors have a higher risk of developing another cancer. Cancer treatments like radiation therapy and some types of chemotherapy increase their risk of developing second cancers. The most common are skin, breast and thyroid cancers.

In LMICs, only about 20-30% of children survive, compared to more than 80% in high-income countries. This inequity makes it difficult to achieve the Sustainable Development Goals and Universal Health Coverage.

Sixty-four percent of Pakistanis are under 30 years old. Diseases and deaths among young people due to cancer or other illnesses impact the country’s economy and undermine sustainable development. The adult population faces problems such as unhealthy diet (including adulteration of food), lack of physical activity, high body mass index (BMI), smoking and alcohol consumption, as well as infections such as hepatitis B and human papillomavirus (HPV). All of these have a role in carcinogenesis. Changing these can help reduce the risk of cancers in adults. With this in mind, community physicians can empower their communities and effect meaningful change.

Common childhood cancers include: leukemia (affecting white blood cells), lymphoma involving the lymphatic system, tumors of the brain and spinal cord, Wilm’s tumor (affecting the kidneys) and retinoblastoma (cancer of the eye ). But what causes cancer in children?

In LMICs, only about 20-30% of children survive, compared to more than 80% in high-income countries. This inequality makes it difficult to achieve the Sustainable Development Goals and Universal Health Coverage.

In children, the main cause of cancer is the inheritance of defective genes. With a high rate of consanguineous marriages, the risk of certain cancers such as leukemia increases. Therefore, early detection and prompt referral are essential. A late presentation or report is associated with poor results.

In LMICs, only about 20-30% of children survive, compared to more than 80% in high-income countries. This inequality makes it difficult to achieve the Sustainable Development Goals and universal health coverage.

We must act quickly because every child with cancer deserves good care. Governments around the world began taking steps to prioritize action against childhood cancer after World Health Assembly resolutions. The WHO Global Childhood Cancer Initiative was launched in September 2018. A clear goal was set. However, much remains to be done to improve childhood cancer survival in LMICs.

Screening for childhood cancers is generally not recommended. Parents and physicians can identify unusual clinical signs and symptoms provided mass education and training of primary care physicians takes place. This brings us to questions such as the effectiveness of identification of common childhood cancers by primary care physicians working in LMICs; or what ongoing training or continuing professional development (CPD) training is offered to primary care physicians to suspect or diagnose pediatric cancers? Early recognition and referral will undoubtedly increase the chances of recovery and reduce mortality from childhood cancers.

Dealing with a difficult situation like this in a weak health system without a structured organization of primary care is a difficult task. Children with these illnesses are often unable to access care. There is a general lack of cancer treatment centers. Financial hardship is one of its main causes, as most families cannot afford cancer treatment.

Non-governmental organizations are counted on to provide expensive cancer treatments that are not accessible to all citizens.

Including cancer treatment in the Sehat Sahulat program has brought some hope to those who cannot afford treatment. However, there are not many established childhood cancer treatment centers in most public hospitals.

The situation requires immediate attention and quick action. In order to bring about a transition in the current pattern of disease identification and treatment, education of parents, especially those from high-risk families, must be prioritized. With the growing burden of non-communicable diseases, including cancers, it is imperative to establish a national cancer database/registry. Improving survival rates through early detection and improving access to the health system, including ensuring adequate funding for affected families, especially in low-income communities, must be enacted.


Dr Hina Jawaid is Assistant Professor of Family Medicine at Lahore University of Health Sciences

Dr Abdul Jalil Khan is Assistant Professor of Family Medicine at Khyber Medical University, Peshawar

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