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Addressing Childhood Cancer in Resource Limited Countries: The Need for An International Collaborative Effort

Issue: Vol.9, No.2 - April 2010

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Article Type: Editorial

Syed Rahman PhD
Research Scientist, BC Cancer
Agency, Canada

Hamish Holewa
BSc. Bed Grad Dip HEcon,
Program Manager, International
Program of Psycho-Social Health
Research, CQUniversity, Australia

With the intention of addressing the needs of children with cancer in Bangladesh, the British Columbia Cancer Agency, Canada, organised an international forum, bringing together key local decision makers and stakeholders from United Kingdom, Australia, Canada and Japan, with international childhood cancer specialists in a two day workshop, entitled 'Exploration and setting priorities for childhood cancer in Bangladesh'. The objective was to explore the incidence and nature of paediatric cancer within Bangladesh and design and implement research and intervention programs aimed at combating childhood cancer in this and other resource limited countries.

The forum affirmed the need for progress and greater collaboration. Childhood cancer is a major health threat in developing countries. Globally, an estimated 250,000 children develop cancer each year, and 80% of them live in developing countries (BBC 2002, American Cancer Society 2007). Eight out of ten of the world's children diagnosed with cancer die without receiving treatment. Eighty percent are either not diagnosed or are denied potentially life-saving treatment (BBS 2002). Four in five are from low and middle income countries where child cancer is just one of many health priorities struggling for resources (World Child Cancer 2009). In resource limited countries, childhood cancer is often detected too late for effective treatment and appropriate treatment is often not available or affordable. Many children are never diagnosed at all, and when a diagnosis is made the treatment
options may be limited (UICC 2006).

The survival scenario in developed countries is quite different. Diagnostic and treatment protocols in developed countries have effectively improved childhood cancer survivorship by 75-80%. In developing countries, by sharp contrast, more than 80% of young cancer patients die (World Child Cancer, 2009).

The childhood cancer situation in Bangladesh is similar to other developing countries. Cancer is one of the major causes of morbidity and the sixth leading cause of mortality in Bangladesh (MOHFW 2008; BBS, 2008). The annual incidence of paediatric cancer in Bangladesh is estimated to be 7000- 9000 cases per year; with less than 500 children receiving hospital treatment (Islam S 2009). Major disparities in access to very limited services between rural and urban areas are also distinctively visible. Most childhood cancer patients die without a proper diagnosis and adequate medical treatment, and more than half of properly diagnosed children still die within five years (MOHFW 2008). If diagnosed at an early stage, and if treatment is available, most childhood cancers are highly curable (Raul et.al 2008).

Using a Nominal Group Technique structured workshop, participants at the Childhood Cancer Forum were asked to decide on a recommendations for decreasing morbidity and mortality of paediatric cancer in Bangladesh. Final recommendations included: the development of a cancer registry to assist in surveillance and measurement of cancer incidence within the population; capacity building for increased timely diagnosis, professional development and physical infrastructure; awareness raising to reduce stigma and to facilitate an increase in health seeking behaviors throughout the population and research on low cost therapy and comparative assessment on treatment protocol.

The recommendations are a positive step forward and reflect international concerns relating to increasing health seeking behaviour within the general population. Also acknowledged was the importance of understanding the psycho-social context in which childhood cancer and treatment is located. This is particularly important as issues such as stigma, have been shown to have a negative impact on health seeking behaviours, treatment accessibility and concordance (Dodor, 2009; Higgins 2009).

Bangladesh does not have a childhood cancer registry to help inform planning decisions across the country. Clearly, there s a large unmet need in the community and the Bangladesh health system faces significant challenges in coping with the burden of childhood cancer (MOHFW, 2008).

The increase in curative based treatment may be a relative slow process in Bangladesh with health priorities directed at communicable diseases such as diarrhoea, tuberculosis and malaria. Additionally, there is an increasing demand on health care resources from non-communicable diseases such as diabetes and heart diseases. (WHO 2010). Whilst having the goal of providing effective treatment for paediatric cancer within the general population is noble, preliminary work needs to be undertaken to aid the implementation of service delivery, professional training, standardised treatment protocols and health structures that support timely presentation and diagnosis. There are also opportunities for the development of community based supportive and palliative care services to reduce the burden and suffering of paediatric cancer (Khan, Ahmad, Anwar, 2008). Such services can be generally inexpensive to run, decrease the suffering and burden of disease and provide a strong platform for psycho-social support post death. Supportive and palliative care service implementation need not be exclusive to the furthering development of oncology services within Bangladesh and can provide a good compliment in professional training and capacity building, awareness raising and reducing stigma.

Research conducted by McGrath et.al (2009) shows that positive outcomes can be achieved by international collaboration. Recommendations from the international forum show that it is an effective method of galvanising opinion and focusing priorities. With international collaboration and research informing decision making it is hoped that this forum will be another step forward to decreasing the morbidity and mortality associated with paediatric cancer in Bangladesh and other resource limited countries.

References
- American Cancer Society (2007). Global cancer facts and figures 2007.
- BBS. (2009) Statistical Pocket Book of Bangladesh 2008. Bangladesh Bureau of Statistics. Planning Division, Ministry of Planning, Government of the People's Republic of Bangladesh.
- Cancer Help Guide. (2008) Child cancer causes thousands of deaths annually in Bangladesh. http://cancerhelpguide.net/child-cancer.
- Islam Saiful. (2009) Health, Economic and Childhood Cancer Profile in Bangladesh. Report of the department of Paediatric Surgery, Bangabandhu Sheik Mujib Medical University, Dhaka, Bangladesh.
- McGrath, P, Holewa, H, Koilparampil, T, Koshy, C & George, S (2009) 'Learning from each other: cross-cultural insights on palliative care in Indian and Australian regions', International Journal of Palliative Nursing 15(10):499-509.
- MOHFW. (2008) National Cancer Control Strategy and Pan of Action 2009-2015, Ministry of Health and Family Welfare, Bangladesh.
- Khan, F., Ahmad, N., Anwari, M. (2008) Palliative Care in a Human Right, Journal of the Bangladesh Society of Anaesthesiologists. 21;2: 76 -79.
- Raul C Ribeiro, et.al. (2008) Baseline status of paediatric oncology care in ten low-income or mid-income countries receiving My Child Matters support: a descriptive study.
www.thelancet.com/oncology. Vol 9.
- Rice, S., McGrath, P. (2010) Successful Australia-India Cancer Research Program Expands to Bring Benefits to other Diagnostic Groups. Austral- Asian Journal of Cancer. 10;1.
- UICC (2006). Childhood Cancer: Rising to the challenge: The International Union against Cancer (UICC) in the framework of the World Cancer Campaign.
- World Health Organisation (2010), Country Health Profile. Accessed on
http://www.whoban.orgcountry_health_profile.html 13 April 2010.
- World Child Cancer facts. (2009) http://www.worldccf.org/. 6 Briset Street, London EC1M 5NR, United Kingdom

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