Early diagnosis and prompt treatment initiation is the fundamental in achieving better results.
Representational image. News18
In India around 50000 to 75000 childhood cancers happen every year, however only 20- 40 per cent are able to avail the facilities in time. Moreover, unlike high income countries where 80% of children with cancer are saved, in India, survival is less than 50 per cent.
Early diagnosis and prompt treatment initiation is the fundamental in achieving better results.
The major reasons of poor outcomes and delayed detection are:
Delayed diagnosis
Lack of awareness:
Among parents: Parents are not aware of red flag signs. Also many of the signs and symptoms in children don’t look alarming and hence are ignored initially as change in the habits of children.
For example parents brought the child with breathing difficulty and was admitted in ICU. The CT scan of the chest was indicative of cancer condition called LCH ( Langerhans cell histiocytosis ). On probing of parents, they revealed that for last few months they noticed changes in the behaviour of their child , like the child use to get up at night , like to drink lots of water ( polydipsia)/ ice cold water sometimes 3-4 litres a day and had started bed wetting (polyuria) which was not there before. This polyuria and polydipsia can indicate towards hormonal disturbances seen in conditions like LCH.
Anything different in child’s behaviour like loss of appetite causing loss of weight, prolonged fever , unexplained bleeding , body aches causing limitation in daily activities , passing red-coloured urine, unexplained hypertension, abdominal distension, painless lump increasing in size gradually, bone wounds not healing , swelling increasing and not decreasing even after few days of injury, white reflex in eyes, vomiting especially morning vomiting causing relief in headaches are few of red flag signs and symptoms which need further investigation.
Among healthcare workers: Since there is considerable overlap of signs and symptoms of cancer with other infectious diseases, many patients are initially treated as infectious disease mainly tuberculosis and because of this precious time is lost and disease becomes advanced.
Lack of Diagnostic facilities:
There is lack of good diagnostic facilities in majority of the cities of the country. Only few metropolitan cities have good laboratories which can provide rapid and accurate diagnosis. Hence many a times there is a misdiagnosis or delay in the diagnosis leading to delay in proper treatment.
Socio economic issues: Lack of insurance and funding especially for middle class families prevent the families to reach the health care facilities where childhood cancer is treated.
Social beliefs and alternative medicines: Many believe in the alternative medicines and they waste their time in giving unproven treatment and disease becomes advanced. Many alternative medicines have steroids in them and it causes temporary relief like decrease in fever but later on ultimately disease progresses and at this stage its becomes difficult to treat them.
COVID-19 issues: Due to the pandemic and lockdown and also reallocation of health care personnel and facilities, cancer treatment suffered a lot. Many patients could not reach the facility in time or could not be treated because of their positive status.
There are many other issues which are unique to ethnicity and local societies , followed by parents education and socioeconomic status which plays an important role in getting the help for the child in time.
Hence as a society, we need to facilitate and create awareness, so that treatment could be provided to many childhood cancer patients.
The author is a pediatric oncologist and BMT physician, Masina Hospital, Mumbai. Views expressed are personal.
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