Friday 30 April 2010
Thursday 29 April 2010
Around 10-15% of all childhood tumours of the brain are in the brain-stem. A majority of these are diffuse and infiltrating lesions of the pons called Diffuse Intrinsic Pontine Glioma (DIPG). Surgical removal of these tumours is not feasible and focal radiation in combination with experimental chemo/biologic therapeutic agents is the mainstay of treatment. Current outcomes across the world are dismal overall survival less than 10 to 15%.
Sunday 25 April 2010
A recent paper reports health-related QOL outcomes in children with cancer from a physicians perspective (Ref - Chirivella et al, Indian J Pediatrics, Dec 2009). 45 patients and their physicians were recruited from two centres in Hyderabad. Using questionnaires, the physicians were interviewed for their assessment of the various HRQOL domains (sensation, vision, hearing, speech, mobility, dexterity, emotion, cognition, self-care, pain). Although its primary objective was a feasibility study, it does show an interesting (and not unexpected) observation of the pain domain having one of the lowest and most variable scores. This is in line with the recent report by Human Rights Watch which found that pain relief during palliation was sub-optimal in India.
Friday 23 April 2010
Thursday 22 April 2010
Thursday 15 April 2010
Tuesday 13 April 2010
Saturday 10 April 2010
Tuesday 6 April 2010
Presenting features of the brain tumour depend on the age of the child as well as the location of the tumour in the brain. However, they can be varied and include headache, nausea/vomiting, visual changes, motor changes, seizures, altered sensorium and others. The non-specificity of some of these symptoms can lead to a delay in parents seeking medical advice and in physicians reaching a diagnosis. These delays can have negative impact on outcomes.
Addendum (08/06/2010) - A recent report shows that the frequency of TEL/AML1 in Far East Asia (Japan, Korea, China, Hong Kong, Chinese in Singapore, and Taiwan) based on a pooled analysis of 1321 children with ALL was 13.4% (Ref - Liang et al, Pediatr Blood Cancer, 2010). This is lower than that reported from the West but higher than that from the Indian subcontinent.
Sunday 4 April 2010
Tumours of the ovaries represent around 4% of tumours overall in females and around 2% of all tumours in children less than 15 year of age. In children and adolescents, germ cell tumours of the ovary are by far the most common pathology (around 70%) among ovarian tumours while in adults, carcinoma of the ovarian epithelium accounts for 85-90% of the ovarian tumours.
Dr Biswajit and his colleagues from a tertiary cancer centre from Chennai have recently published outcomes of 40 girls less than 18 years of age with ovarian germ cell tumours who were managed in their institute from 1990 to 2002 with cisplatin-based chemotherapy and surgery (Ref - Biswajit et al, Journal of Pediatric Hematology Oncology, March 2010). Nearly 2/3rd of the patients presented in Stage III-IV. Delays in diagnosis and treatment could have been due to patient-related factors or due to healthcare-related delays although this was not specifically studied. The 5 years disease-free survival was 72.8% (mainly because of relapses in 25% of patients) and overall survival was 94.9%. Similar results were reported from Tata Memorial Hospital in Mumbai nearly 15 years ago although they had less relapses (Ref - Kapoor et al, Journal of Pediatric Hematology Oncology, November 1995).
Thursday 1 April 2010
Attempts have been made in the past to contact the children and families of those who abandon treatment. There are a very few studies looking at this and their dissemination has been limited to scientific proceedings. The recently published paper from Indonesia (Ref - Sitaresmi et al, Psycho-Oncology, April 2010) is the first extensive analysis of child and parent attitudes and behaviour to explain this complex problem. The authors conducted home-visits to interview families of 37 acute leukaemia patients, diagnosed between January 2004 and August 2007, who refused or abandoned treatment. There was no relation of abandonment with age, risk stratification of leukaemia, class of hospitalization (marker of economic status), parental education level and travel time. Girls abandoned slightly more often but this difference did not reach statistical significance.
Financial difficulties and a belief in the incurability of acute leukemia were the leading reasons given by parents for abandoning treatment. Additionally, treatment-related toxicity, painful procedures performed with inadequate analgesia and sedation, inadequate communication provided by health care providers and transportation difficulties were contributing reasons.