Cancer survival rate in children rising – experts

Ten children healed from cancer will take to the red carpet at the Paediatric Oncology Unit at Mulago Hospital in celebration of surviving one of the most debilitating non-communicable diseases in the country.

The celebration at Mulago is part of the International Childhood Cancer Day (ICCD) that will be marked today. 
ICCD is a global collaborative campaign to raise awareness about childhood cancer and to express support for children and adolescents with the disease, as well as the survivors and their families.

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This year’s ICCD is being marked under the theme, “Better survival is achievable through their hands.”
The number is just a grain in a sack of the 400 currently on treatment at Mulago Children’s Cancer Ward. But with the survival rate of children with cancer doubled from 35 percent three years ago, at least 12 children survive when they receive appropriate and timely medical care.

To this, stakeholders believe the ray of hope is twinkling.
“We diagnose about 300 children with cancer at Mulago every year. These have varying periods of treatment ranging from a few months to over three years,” Dr Peter Wasswa, a senior consultant paediatrics hemato-oncologist at Mulago, said.

Childhood cancers, the commonest of which include acute leukaemia (blood cancer), lymphoma, kidney cancer, neuroblastoma (a nervous system cancer), brain tumours, muscle and soft tissue cancer, and germ cell tumours are curable but paediatric oncologists are often at pains that early diagnosis remains elusive.

It is estimated that nearly 5,000 children develop cancer every year in Uganda. But only about 20 percent of these are diagnosed or get treatment. 

“Most children with cancer in Uganda remain undiagnosed and die without treatment,” Dr Wasswa, who is also the director of the Global Hematology-Oncology Pediatric Excellence (Global Hope) programme at the national referral hospital, said.

He added: “Underdiagnosis can be partly explained by poor health-seeking behaviour, whereby a proportion of families attribute unusual symptoms to witchcraft or other causes and fail to seek care from competent healthcare facilities. Some families flatly refuse to believe a cancer diagnosis or refuse to take children for treatment in the mistaken belief that treatment is futile.”

Parents are also kept away by the fear of the burden of the cost of treatment.

Whereas medics say it is almost impossible to quantify what it takes to treat cancer due to the lengthy regimen involved, using leukaemia, a straightforward treatment would cost an average of Shs2.6m for the lower risk and Shs3.5m for the full course of treatment over three years.  

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This excludes additional costs such as blood tests and other investigations both at diagnosis and monitoring levels. For example, a patient with Wilms tumour (a kidney cancer) will need a minimum of three CT scans, each costing Shs200,000. 

There are also costs for radiotherapy, supportive care such as medicines to treat complications.
Dr Wasswa, a former assistant professor of paediatrics at Texas Children’s Cancer and Hematology Centre in the US, said because of weaknesses in the registration and reporting systems, the true incidence of childhood cancer in Uganda is unknown.

Global Hope works with other partners such as the Lions Club International, whose district 411B (Uganda) governor Dans Nshekanabo said has invested $500,000 (Shs1.8b) in the Mulago Children Cancer Ward.
“The high-level treatment offered is free of charge. But the problem is, most people don’t know and many children are brought in when it is late,” Mr Nshekanabo told Monitor.

Childhood cancer burden
The hope is that more children are diagnosed early and this will take several efforts, including equipping the paediatric oncology unit, training and staffing, awareness and innovation and research.

There would also be the need for targeted legislation to include childhood cancer care as an essential service.
“It is true that we are seeing more children with cancer than, say, a decade ago,” Dr Wasswa said.

 In sub-Saharan Africa, 240,000 children develop cancer annually with more than 100,000 deaths reported each year. 

Only 10 to 25 percent of these children in countries such as Uganda are estimated to survive the disease. In high-income countries such as the US with advanced treatment interventions, the rate of survival is as high as 85 percent. 

Mr Bayo Fatunmbi, the World Health Organisation cluster lead for communicable and non-communicable diseases, has called for the tracking of performance on enhancing access to cancer treatment and enhancing resources to tackle the disease.

“Sub-Saharan Africa could soon account for half the world’s cases of cancer in children unless the disease is prioritised through a robust national plan,” Ms Michelle Mugyenyi, the programme manager for Global Hope, said.

Dr Charles Oyoo Akiya, the commissioner for non-communicable diseases at the Ministry of Health, last year said the government has prioritised cancer among the five main target diseases needing high and strong engagement and support.

However, efforts to get a rejoinder on how this alignment has been tracked over the last 12 months were futile as the Health ministry spokesperson, Mr Emmanuel Ainebyoona, could not readily respond.

Signs of childhood cancer
The symptoms and signs of childhood cancer often mimic those of common childhood illnesses. For example, fever, limb pain and anaemia can be symptoms for malaria but are also symptoms of blood cancer (leukaemia).

The key is having a high degree of suspicion, especially if the symptoms are persistent, or the results for common diseases, say malaria are negative. Also, where common treatments for a presumed common childhood illness have failed to work beyond a reasonable time frame.