Right care at the right time by the right team

Each year, the International Childhood Cancer Day (ICCD) is marked on February 15. In the year 2022, we are continuing with the 3-year theme of ICCD (2021-2023) of ‘Better Survival’ achievable through your hands, which is focused on the role of medical teams. This is a time to reflect on the positive impact that healthcare workers can have on the lives of children with cancer.

Cancer in childhood can have a devastating impact on the child and their family. In low- and middle-income countries such as Pakistan, there are significant barriers to reaching the “right care at the right time by the right team”. In the long journey, from symptom onset to the administration of appropriate treatment, children face worsening disease severity, social isolation and emotional distress while their families are faced with increasing financial costs. Parents may downplay some early signs of cancer or seek treatment from shamans. Even if these children are taken to local doctors, physicians in rural or inner-city settings do not have the experience or skills to diagnose childhood cancer or refer these children to specialist cancer centres. An inappropriate diagnosis may lead to harmful or unnecessary treatments. Sometimes, despite an appropriate referral, family members may delay seeking care due to a lack of understanding of the diagnosis or the resources to travel.

The treatment duration for childhood cancer can range from a few weeks to a few years, depending on the diagnosis and treatment plan for the type of cancer. If this care is fragmented over multiple institutions, miscommunication between treating physicians may lead to poor care and families may become tired of navigating multiple healthcare systems, leading to treatment abandonment. It is not uncommon for us to see children who were handed a wrong cancer diagnosis, undergo surgery for a cancer that could be treated with chemotherapy or for a child to receive the wrong type of chemotherapy.

Specialist cancer centres such as Shaukat Khanum Cancer Hospitals in Peshawar and Lahore are institutions dedicated to providing multidisciplinary cancer care under one roof. An essential element of this care is the use of multidisciplinary tumour boards. These tumour boards include paediatric oncologists, radiologists, radiation-oncologists, surgeons and pathologists. Through a collaborative approach, a consensus on correct diagnosis, stage and the most appropriate treatment is reached for each patient with cancer. Often, each type of cancer will have a dedicated team of experienced healthcare professionals that conduct specialised weekly tumour boards, such as the sarcoma tumour board for children with bone and soft tissue cancers. In addition, we provide vital supportive care to children with cancer at our hospitals including specialised nursing and emergency services, diagnostic testing, psychologists, nutritionists, physical therapists and hospital-based teachers. We also provide nutritious meals to all patients admitted under our care, as well as to the parents of children admitted to the hospital. This aims to provide equitable access to cancer care to our patients because over 75 percent of all our patients come from low-resource settings and receive financially supported care. These services ensure that all aspects of the child’s physical and mental health are being addressed. Once a child has completed therapy, they are seen in long-term follow-up clinics where they undergo comprehensive evaluations for any side effects of therapy. The goal is to re-integrate children into a normal childhood after their therapy is complete. In addition, as some cancers may run in families, these centres provide vital information to parents about screening other children for cancer.

Specialist cancer centres are also actively engaged in research into better ways to diagnose, treat and even prevent cancer. Using dedicated cancer registries, they identify care gaps in childhood cancer, highlighting opportunities for improvement. Shaukat Khanum Hospitals also routinely collaborate with other cancer centres nationally, regionally and internationally, sharing knowledge and expertise through scientific conferences, multi-institutional research projects and tumour boards. Physicians working at Shaukat Khanum are often also serving on international research consortia and engaged in bringing global advancements in cancer care to Pakistan.

The development of cancer centres and a robust nationwide network of referral can go a long way in improving survival of children with cancer. National awareness campaigns that target medical professionals to recognise the signs and symptoms of childhood cancer and make an early referral to a specialist cancer centre can help save a child’s life by getting the “right care at the right time by the right team”.

The writer is a Consultant Paediatric Oncologist at SKMCH&RC, Lahore.

Cancer in childhood can have a devastating impact on the child and their family.

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