By Dr. Dineshani Hettiarachchi Sirisena
Each year, 15 February marks International Childhood Cancer Day (ICCD). On this day we raise awareness on the challenges faced by children and adolescents with cancer around the globe. In this light, we spoke to the Ministry of Health National Cancer Control Programme Consultant Community Physician Dr. Suraj Perera.
What are childhood cancers?
Cancers occurring between the ages 0–19 years are called childhood cancers. Since teens are also included sometimes it is also called childhood and adolescent cancers. The most common cancers among children and adolescents are leukaemias, lymphomas, tumours arising in the brain and spinal cord (central nervous system), kidney tumours, and bone tumours, stated Dr. Perera.
Theme and objective of commemorating International Childhood Cancer Day
As stated above, International Childhood Cancer Day is commemorated throughout the world every year on 15 February. The concept of commemorating International Childhood Cancer Day was introduced in 2001 by Childhood Cancer International (CCI), which is the umbrella organisation for supporting childhood cancers comprising cancer societies, organisations of parents of the childhood cancer patients, childhood cancer survivors, and other civil society organisations contributing for the betterment of childhood cancer patients and their caregivers.
Gradually from the year 2002 onwards, this day is commemorated throughout the world as an advocacy activity for policymakers and an awareness-raising activity about childhood and adolescent cancers among the general public to express support to children and adolescents with cancers, the survivors, family members, and health and non-health caregivers.
The main theme for this year is ‘better survival is achievable’. This theme is considered for three years from 2021 to 2023 with an extended sub-theme for each year highlighting the contribution of sub-segment of the population, stated Dr. Perera.
|Year||Sub-theme||Sub-segment of the population|
|2021||# withourhands||Children and adolescents with cancer|
|2022||# withyourhands||Health care teams|
|2023||# withtheirhands||Families and caregivers|
Therefore, this year’s extended theme is ‘better survival is achievable #withyourhands’. This year’s theme highlights the importance of health care professionals’ active participation and their positive impact on the lives of children and adolescents with cancer. It also pays special tribute to the dedicated services rendered by healthcare personnel for this cause.
This theme is also aligned with the Global Initiative for Childhood Cancer of the World Health Organization. The WHO Global Initiative encourages all countries towards achieving at least 60% survival for childhood cancers in the year 2030 and reducing the suffering of the affected child and their family.
Sri Lankan response to International Childhood Cancer Day
In Sri Lanka too, this day has been commemorated during the last few years by the Department of Paediatric Oncology of Apeksha Hospital (National Cancer Institute), the National Cancer Control Programme, and some civil society organisations.
In the year 2021, the ‘National Strategic Plan on Childhood and Adolescent Cancer Care in Sri Lanka 2021-2025’ was developed in partnership with different stakeholders including Ministry of Health officials, professional colleges, clinicians and other healthcare staff, development partners, and civil society organisations. Ensuring implementation of identified strategies and major activities of the National Strategic Plan will be the priority to achieve better survival from childhood cancers, stated Dr. Perera.
Incidence of childhood cancers globally as well as locally
About 400,000 cancers are reported per year throughout the world among children and adolescents. In developed countries often, childhood cancer cure rates exceed 80%. But in developing countries, the survival rates of childhood and adolescent cancers may vary and it can be as low as 20%. Therefore, WHO states that children with cancer in developing countries have a four-fold increase in the risk of dying than children in developed countries due to delay in diagnosis and inadequate treatment facilities.
According to the National Cancer Registry of Sri Lanka, a total of 31,834 new cancer cases have been detected and out of that 778 cases are below the age of 19, making it 2.4% of all cancers. Among all childhood cancer cases reported in the year 2019 in Sri Lanka, 51.4% are males while 48.6% are females, giving a 1:1 ratio of incidence.
Figure 1: Number of 0-19 years newly diagnosed childhood cancer patients by sex in Sri Lanka, 2005-2019
As stated earlier, the most common childhood cancers reported in Sri Lanka are leukaemias, lymphomas, brain tumours, and bone tumours.
On average about 250 deaths per year occur due to childhood cancers, according to the cause-specific death data published by the Registrar General Department. Overall male: female ratio of mortality of childhood cancer was nearly 1.2:1. The highest number of deaths due to childhood cancers occurred due to leukemias and brain tumours.
Survival rates of childhood cancers are not available routinely in Sri Lanka since the current cancer registration system in Sri Lanka does not contain adequate follow-up data. Therefore, to overcome this limitation, in the year 2021 the Hospital-Based Childhood Cancer Registry was commenced in partnership with the WHO Country Office and St. Jude Global Alliance using the SJCARES cancer registry platform. However, through limited research evidence, it was revealed that already more than 60% survival has been achieved for acute lymphoblastic leukaemia and Wilms tumour.
The detailed information on the burden of childhood cancers in Sri Lanka is available in the Childhood Cancer Registry of Sri Lanka published in the year 2021. The publication is available online at https://www.nccp.health.gov.lk/en/incedenceData, stated Dr. Perera.
Thoughts on primary prevention and screening of childhood cancers
Unlike adult cancers, the aetiology of most childhood cancers remains unclear, as they are not related to unhealthy lifestyles. Additionally, most cancers are not inherited as well. Therefore, the primary prevention of childhood cancers is not a feasible strategy. However, the practice of healthy lifestyles needs to be promoted from childhood days onwards because the risk of exposure to unhealthy behaviour may lead to the initiation of adult cancers from the adolescent period onwards.
Also, there is no identified methodology for screening childhood cancers as reemphasised by the WHO through the publication named ‘A short guide to cancer screening. Increase effectiveness, maximise benefits and minimise harm’ released this year.
Therefore, the emphasis should be on early diagnosis, prompt treatment and follow-up care. So parents need to be aware of possible warning symptoms. If these symptoms persist, prompt action is required, emphasised Dr. Perera.
What are those warning symptoms?
Those key symptoms are listed below and those symptoms have a pneumonic called ‘CHILD CANCER’
Continued, unexplained weight loss
Headaches with vomiting during the early night or early morning
Increased swelling or pain in bones, joints and legs
Lump or mass in abdomen, chest, pelvis, or armpit
Development of excessive, bleeding, bruising, or rash
A whitish colour behind the pupil
Nausea which persists or vomiting without nausea
Constant tiredness or noticeable paleness
Eye or vision changes which occur suddenly and persists
Recurrent fevers of unknown origin
If these symptoms persist, parents or guardians of the child or adolescent should seek medical advice through the family doctor or from the nearest hospital without delay, reiterated Dr. Perera.
Current and future initiatives to close this gap
To minimise the delay in identifying suspicious symptoms of childhood cancers, parents need to be empowered. Also, health care workers need to be regularly updated on childhood cancers. The key interventions were identified at the National Strategic Plan.
What advice do you have for parents of children diagnosed with cancer?
Most childhood cancers are treatable and even curable. Therefore, to achieve a complete cure, the full course of treatment needs to be completed. There might be myths related to them being contagious and it’s important to state that childhood cancers are not contagious.
Due to cancer itself and its treatment, the child’s immunity may be affected, making them more vulnerable to infections including contracting severe Covid-19 infection. With the advice of the treating consultant, if the child is eligible for the Covid-19 vaccination schedule, the Covid-19 vaccine needs to be given, pointed out Dr. Perera.
Resources available for the general public/parents of children with cancer
All the childhood cancers are treated at the National Cancer Institute under the leadership of consultant paediatric oncologists or consultant oncologists with a special interest in paediatric oncology.
Take home message
Most childhood cancers are curable through early identification and prompt treatment. Therefore, better survival is achievable. Health care staff need to be empowered regularly for the provision of dedicated quality holistic care for the children and adolescents with cancers, concluded Dr. Perera.