According to a recent National Cancer Registry Programme (NCRP), childhood cancers in the 0–14 age group accounted for 4% of all cancers in India

One pediatric oncologist is available in less than half of the tertiary hospitals in India and less than 50% of the public tertiary hospitals have stocks of the four categories of cancer-treating drugs and essential infrastructure for radiotherapy and chemotherapy, says a survey published in Lancet.

Similarly, most secondary-level hospitals not treating childhood cancer had referral linkages with tertiary hospitals.

The survey was conducted in 137 tertiary-level and 92 secondary-level hospitals in 26 states and 4 Union Territories (UTs), ensuring a uniform representation of public and private care hospitals. The study tool collected data on the organisational infrastructure, type of oncology services, health workforce, equipment, treatment and referral protocols, and treatment guidelines.

“Besides a shortage of trained doctors, the issue of poor childhood cancer outcomes is compounded by resource constraints.” the survey found. “In our study, public tertiary hospitals reported low availability of nurses trained in pediatric oncology, advanced diagnostic modalities, bone and PET scans, childhood cancer dedicated beds and physical infrastructure for chemotherapy administration, and insufficient stock of chemotherapeutic medicines compared with private hospitals.”

In contrast, Ukraine had the highest ratio of pediatric oncologists per childhood cancer patient (1:4), followed by the Philippines (1:10), Egypt (1:23) and Venezuela (1:28). The ratio ranged from 1:50 to 1:750 for the other Low- or Middle-Income Countries (LMICs) – Bangladesh, Honduras, Morocco, Senegal, Tanzania and Vietnam.

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Childhood cancer treatment

Pediatric oncology is in an emerging phase in India and is still lacking in terms of international standards. “Earlier studies have shown that pediatric oncologists were available in 10% of the cancer centres in the late 80s’.Despite this notable improvement, the mortality-to-incidence ratio for childhood cancers ranges from 17 to 72% in India, compared to 20–24% in the United States and Britain,” the study reads.

The childhood cancer-treating drugs are available at less than 50% of the public tertiary hospitals for the four categories of cancer-treating medications, while the majority of the private and NGO managed hospitals had supplies of all four drugs available. The availability of targeted therapies was the lowest (35.4% in public tertiary hospitals, compared to 66.8% in private and 68.8% in NGO managed hospitals). Free medicines are available in less than 40% of the tertiary hospitals, the lowest availability being in private hospitals.

According to a recent National Cancer Registry Programme (NCRP), childhood cancers in the 0–14 age group accounted for 4% of all cancers in India. The country doesn’t have a specific programme component or policy to address childhood cancer.

There is limited information on the status, distribution, and quality of childhood cancer care services in India. Most studies have been done in selected geographic settings and do not provide a comprehensive country presentation.

The first paediatric oncology unit in India was established in the 1960s and the number of such units has been increasing since the 1980s. A national survey of childhood cancer services conducted in 1988 observed that paediatric oncology cases were handled by adult oncologists in 50% of the surveyed centres.

Most paediatric cancer care centres in India are urban-centric, leading to delayed access by the rural population. It is seen that children with cancer often present with an advanced-stage disease which worsens the outcome.

The need of the hour, the study advocates, is to formulate a National Childhood Cancer Policy that comprises early detection, access to affordable care, and comprehensive supportive care services through well-defined care pathways at public health facilities.

“Adopting the shared care model approach incorporating palliative care into the practice of pediatric oncology could enable the development of a national collaborative policy that would address disparities in access to childhood cancer care,” the study says.

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