September is a childhood cancer awareness month

Childhood Cancer: The salient facts you ought to know.

September is a childhood cancer awareness month. In commemorating it, we highlight the salient facts you ought to know about cancer in children. More than 80% of children with cancer achieve complete remission in high-income countries – yet only 15 to 45% of those in low- and middle-income countries do so. The lower survival rates in the low- and middle-income countries (LIMCs) are attributable to factors that we can amend and avoid this glaring embarrassment.

About 400,000 children and adolescents receive a cancer diagnosis annually. Leukaemia, brain cancer, lymphoma, neuroblastoma, and Wilms tumour, are the most common culprits.

Most of these cancers have no identifiable causes or risk factors. However, in about 10% of them, a genetic predisposition is apparent. In a few case scenarios, HIV, Epstein-Barr virus, and malaria are to blame, especially in LMICs where they are prevalent.

Because childhood cancer aetiology is still elusive, prevention isn’t a straightforward game to play. But we cannot whine about it. A few are preventable through extended immunisation programmes. For example, hepatitis B vaccination to prevent liver cancer, human papillomavirus immunisation to prevent cervical cancer. For the other scenarios, it is imperative to focus on early detection, prompt diagnosis, and an exhaustive multi-team management approach.

The rate of cure of childhood cancer in the LMICs is appalling compared to that of the high-income nations. Several reasons account for the contrasting rates.

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There’s a substantial delay in diagnosis due to a lack of impactful knowledge about symptom identification and investigation modalities among parents and clinicians. Most of these children receive treatment for either a bacterial infection or septicaemia for prolonged periods before a referral for further management, which, in most cases, occurs by chance. You may be shocked by how many health care workers can interpret a complete blood count with ease: and how many of them can request and analyse a peripheral blood film. Yet, these are basic investigations that can raise a red flag, especially in liquid tumours like leukaemia. The affected children thus reach the cancer treatment centres with an often advanced disease that’s unresponsive to conventional therapy.

Where there’s a diagnosis, the appropriate therapy is inaccessible. When available, several children abandon treatment. Those that persevere may succumb to the toxicity that emanates from chemotherapy.

Few hospitals can perform a bone marrow aspirate or biopsy in Uganda. Histopathology is only possible in about two or three cities in a country of more than forty million people. We can rarely expect an early diagnosis in such scenarios. The situation is more or less the same in many countries within Africa.

Cancer treatment entails chemotherapy, radiotherapy, and surgery – one or all modalities depending on the type of cancer. We (Ugandans) currently have one radiotherapy machine that caters for the entire population. You can imagine how many of the children will get early access to treatment when they need one. Besides accessibility, treatment remains costly: monitoring for side effects is below par.

That said, we strive to increase the survival rate among children with cancer by at least 60% by 2030. It implies that there should be deliberate efforts put forth to achieve this. They include a collaboration with the appropriate organisations like the World Health Organisation to increase awareness among communities. Governments in LMICs should deliberate to inject more funds into the health sector and improve its capacity to treat childhood cancers.

Community awareness can improve the probability of a correct, prompt cancer diagnosis. We should establish and maintain childhood cancer data systems to drive continuous improvements in quality of care and inform policy decisions. We can avoid premature deaths if we diagnose the cancers early enough, institute appropriate treatment and monitoring. And remove obstacles to care access and reduce abandonment. It is prudent to note that most childhood cancers can go into remission with the right therapy that includes chemotherapy, with or without surgery and radiotherapy.  September is a childhood cancer awareness month: we should make it count.

 

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