Cancers in children are rare. They are quite different from cancers seen in adults. In India it estimated that around 2 to 15 children for every 1 lakh population develop cancers. It is estimated that around 50000 children diagnosed with cancers every year. Children are not small adults, their needs, physiology, tolerance to chemotherapy, affect on their behaviour, development and the impact on their siblings, parents makes it a unique specialty.
In the developed world, Paediatric oncology specialty was established in 1960s. Prior to this children with cancer were treated by adult oncologists or by paediatricians. They developed dedicated pediatric oncology centres where trained pediatric oncologist, chemotherapy nurse, dietician, psychologist and social worker work together. As the childhood cancers are rare, pediatric oncologists got together and started cooperative group and then clinical trials find the best treatment. Following successive clinical trials, adoption of uniform guidelines, they have shown in the improvement in survival of childhood cancer to the tune of 80%. Currently in the west, for common childhood cancers such as Acute lymphoblastic Leukaemia (ALL) the survival rate is around 85% and for Hodgkin’s lymphoma around 95%. Success in pediatric oncology is the important milestone in modern medical history.
In India, pediatric oncology specialty is started in many parts in the last one decade. The structured post graduate training in pediatric oncology was not there in India until few years ago. Many of the pediatric oncologists currently working in India underwent training in abroad. Majority of pediatric oncologists are available in mainly in metro cities or in state capitals. Only few tier 2 cities have dedicated pediatric oncology centres. The chapter of pediatric haematologists and oncologists was started under Indian academy of Paediatricians (IAP) body in 1990s. Off late we have formed InPOG – Indian Pediatric Oncology group which started multicentric clinical trials. The focus of InPOG is to cost-effective and logistically feasible protocols for Indian children rather than following blindly imported western protocols. There is a big gap in the pediatric oncology service both in government and private sector in some part of India. Many children still do not have the access to proper treatment in some parts of northern and north eastern states. In the south, these days majority of children receive treatment, thanks to various government health schemes for economically weaker section.
There is still a need of good number of pediatric oncologists to serve all the 50000 new cases seen every year. Improving the structured training programmes, encouraging the pediatricians to take up this subspecialty and working together to develop a uniform guidelines in the management will help in improving the survival rate of childhood cancers.
Dr Harsha Prasada L
Consultant Paediatric hematologist and Oncologist
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