BY STAFF REPOTER
Nuclear is an expensive technology that is often difficult to afford for many developing countries. However compared to the indispensable solution it provides for the health sector, it is worth paying for.
Among the benefits of
the technology is its role in providing radiological treatment for diseases
like cancer. While its significance is undeniable for the treatment of such
diseases, looking at the example for treatment of pediatric cancer is
worthwhile.
Childhood cancer is rare, but when measured in terms of the potential life-years that may be lost, it represents the fourth most important malignancy after lung, breast and colorectal cancers. Fortunately, the types of cancer that are seen in children, and their biology, differ significantly from adult cancers; many paediatric cancers respond well to treatment and more than 80 per cent of children in high-income countries (HICs) are now cured. However, 90 per cent of children in the world live in low- and middle-income countries (LMICs), where cure rates are significantly lower. Although children represent only 2 per cent of cancer patients in Europe and North America, the proportion is as high as 5 per cent in some countries. Sadly, most children with cancer living in LMICs have limited access to modern cancer diagnosis and management and few can benefit from modern and complex therapies, such as radiation therapy. As a result, more than 90% of all childhood cancer deaths occur in LMICs.
Similarly a study conducted in Gondar University Hospital shows that Childhood cancer becomes a public health problem in developing countries which aggravates the burden of childhood mortality by infectious diseases and malnutrition. In poor countries, the death rate for most pediatric cancers is almost 100 %. This study attempts to determine the magnitude, patterns and trends of pediatric malignancies in the study area which is important in re-evaluating existing services and in improving facilities and patient care.
The study shows increasing childhood cancer cases over the years. Hematological malignancy takes the leading prevalence followed by Wilms tumor and Neuroblastoma. The majority of cases were also discharged without any clinical change that had the only death option. Therefore, the government and the hospital should give emphasis to establish cancer therapy centers and insure accessibility and affordability of chemotherapy drugs.
Numbers of radiation oncologists were fewer in resource-limited countries and a dedicated role in paediatric radiotherapy was less common. However, only a minority of paediatric radiation oncologists took responsibility for paediatric chemotherapy in any setting and paediatric oncology and surgery departments were usual. Diagnostic facilities were available in most centres surveyed, including pathology and radiology departments, although imaging technology above computed tomography scanning level notably declined with income bracket. Overall, a striking difference was the sequential decrease in multidisciplinary tumour board management, a methodology of care that has a proven impact on treatment decision making.
The availability of supportive services, such as hostel beds and free transport facilities, also declined. Anaesthesia for young children during radiotherapy was available in more than 90 of the centres surveyed, both in HICs and LMICs. Longterm follow-up of survivors into adulthood was more common in higher income environments, with some evidence that this is more commonly undertaken by the radiation oncologist in lower income environments and through paediatric services in HICs.
Radiotherapy department staff and technology (Table 2) Numbers of medical physicists and radiotherapy technicians in radiotherapy facilities decreased with income bracket, which may affect both the quality and the flexibility to increase efficiency with an extended day working. All centres in HICs had linear accelerators and use of cobalt teletherapy in paediatric patients was uncommon; in lowincome environments, this was the only equipment available in two of three centres. Increasing use of fluoroscopic simulation and a decrease in the availability of a dedicated computed tomography scanner for radiotherapy planning was also seen, although in general computed tomography was available within the hospital. Access to advanced technology features, such as electronic portal imaging,
Radiotherapy, used in combination with chemotherapy and surgery, continues to be an essential part of paediatric cancer management. In common with other medical disciplines, paediatric radiotherapy in LMICs faces many obstacles due to social and economic problems, which could be overcome by close collaboration of health authorities, academic institutions and international organisations. However, paediatric cancers are not common; many radiotherapy centres treat only a few patients annually and do not invest in dedicated resources. The infrastructure, equipment and staff necessary for optimal radiotherapy of paediatric patients, such as immobilization equipment in child sizes, anaesthesia equipment, postanaesthesia recovery rooms, play areas and support staff experienced in childcare (nurses, social workers), are either inadequate or not available in many centres globally. Deficiencies are also apparent in training syllabi; paediatric radiotherapy is not part of the training curriculum in many countries, and most radiation oncology graduates will have treated few paediatric patients.
However, paediatric cancer treatment is not necessarily expensive when resources are used properly and treatment of children with cancer is cost-effective in LMICs.
Survival of paediatric cancer patients in HICs increased significantly starting from the 1970s, with optimum use of early chemotherapy drugs (e.g. cyclophosphamide, vincristine, doxorubicin, 5-fluorouracil and cisplatin) and two-dimensional radiotherapy using cobalt-60 machines, proving that it is possible to reduce childhood cancer .
The Ethiopian Herald 11 April 2021
