Happy International Childhood Cancer Day

Fertility in India: Fertility Preservation in Children with Cancer in ...

Fertility in India: Fertility Preservation in Children with Cancer in ...: The use of chemotherapy, radiotherapy and surgery in the treatment of children with cancer has implications for their future fertility. Gui...

The Cankids Pediatric Palliative Care Day Care & Transition Home

I have known Poonam for a few years (www.cankidsindia.org) and watched in bewildered awe as her organisation has gone from strength to strength and now has a national presence. An important part of her efforts has been to establish a Day Care & Transition Home in Delhi. This dream is finally achieved today and the Home, which is located in proximity to AIIMS and Safdarjung Hospitals, has been opened today. I have been there last year when it was being developed and the ambition of the project as well as the attention to detail is incredible. I wish Poonam and her organisation many more such successes.

Good old, Ginger

The recent Pediatric Blood cancer made for happy reading when I saw the very interesting piece of work from AIIMS on the use of GINGER in the control of nausea and vomiting in children with cancer (Pillai et al, PBC, 2011). It is encouraging to see that this root, which is so essential to Indian cooking, has been harnessed for therapeutic use. Dr Bakshi and his team should be congratulated on a simple well-designed trial with a clear message. I look forward to use of ginger and its effect in other settings, other centres, and other chemothrapy regimens.

Communication in Paediatric Cancer Patients: A Parent's Perspective

Clear and honest communication done sensitively is important in the holistic management of children with cancer and their parents. Little research has been done in India to assess the health information needs of sick children (and their parents). Also the quality and adequacy of information given by health professionals not been looked at.

To address this knowledge gap, Dr Tullika Seth, a haematologist at All India Institute of Medical Sciences has done a pilot study where she interviewed parents of children aged 10 to 18 years with acute lymphocytic leukaemia (Seth T, Indian Journal of Palliative Care, Jan-Apr 2010). The results clearly show that in the Indian context, parents wanted little information to be shared with their children (65% did not want their children to be informed of the diagnosis; 60% did not want the child to be informed about side effects of therapy and especially about long term effects). There was even a stronger opinion about not involving children with decision-making (95% did not want them to involved with making any decision about the treatment; 100% did not want them to involved with making any decision about stopping curative treatment when such a situation arose).

These findings would be useful to health professionals in "forging an alliance with the family to facilitate communication" as Dr Seth says. They also offer us insight into the different attitudes and practices in India compared to the Western context, where patient autonomy is more visible.

Extraocular Retinoblastoma in India

Retinoblastoma is the most common cancer of the eye in children and accounts for 2.5 to 4% of all childhood cancers. When a child is diagnosed with retinoblastoma, the cancer may be limited to the eye globe (intraocular) or have spread beyond the eye globe (extraocular). The spread may be local (to the orbit and local lymph nodes) or more distant i.e metastatic. Delays in presentation in India lead to more than half of the children with retinoblastoma having the cancer spread outside the globe at diagnosis.

Ref - Sahu et al, Pediatric Hematology Oncology, Nov-Dec, 1998

Sameer Bakhshi and his colleagues describe the treatment and outcome of 25 children with extraocular but non-metastatic retinoblastoma over a 5 year period (2003 to 2008) from one of the premier treatment centres in India. The overall survival figures are not given but at a median follow up of 28.5 months (nearly 2½ years) 13 of the 25 children had progressed/relapsed.

Ref - Bakhshi et al, Journal of Pediatric Hematology Oncology, Mar 2010

All those who progressed or relapsed, either refused or did not respond to second line treatment which implies that they would all ultimately die of the cancer. One also needs to consider that there were 51 children with extraocular non-metastatic retinoblastoma during this time period but only 25 opted for treatment. Many if not all of those who did not opt for treatment for various reasons are also likely to have succumbed to the cancer. These poor outcomes are all the more significant as majority of the children in India with retinoblastoma present late and the disease has spread locally or systemically. Hence, it is not surprising that the five year overall survival of children with retinoblastoma (all stages combined) is less than 50% while that in Europe and North America is 95% and above.

Ref – Swaminthan et al, International Journal of Cancer, June 2008