Childhood Cancer In India Research Articles

Sex Bias in Treatment Abandonment of Childhood Cancer in India.

To explore the magnitude of sex bias and determinants of treatment abandonment (TA) in childhood cancer in India. Individual data of children (0-19 y) registered between January 1, 2017 and July 31, 2022, was compiled. TA was defined as defaulting curative intent treatment ≥4 wk. Defaulting treatment irrespective of intent ≥4 wk was defined as Treatment Default (TD). The primary outcome was the proportion of male-to-female children with TA. Secondary outcomes included the proportion of male-to-female children with upfront TA, TA at relapse, TD, TD-p (TD only in the palliative setting). The impact of clinico-demographic factors on TA was analysed using multivariable regression and propensity score matching (PSM). Three thousand two hundred eighty four patients were analysed. The overall male-to-female ratio (MFR) was 2.08 (95% CI 1.94-2.24). Of 2906 patients treated with curative intent, 415 (14·3%) abandoned treatment. TA was higher in females than males (16·4% vs. 13·3%; p = 0·022) with adjusted MFR of 0·81 (0·66-0·98). The adjusted MFR of TA for treatment-naïve and relapsed patients and TD were 0·73 (0·59-0·91), 1·13 (0·65-1·96) and 0·84 (0·71-1·00) respectively. Sex independently predicted TA on multivariable analysis. However, on PSM analysis including socio-economic variables, lower maternal education predicted higher TA in children with cancer (10·1% vs. 6%, p = 0·015). Child sex predicted TA in childhood cancer in India with more females abandoning treatment. Maternal education is a more crucial factor predicting TA over child sex, when socio-economic factors were considered. Hence, policies promoting female education and gender equality may mitigate sex-based gaps in childhood cancer care.

Childhood Cancer in India: Miles to Go Before We Sleep!

Childhood Cancer in India: Miles to Go Before We Sleep!

Bridging the gender gap in childhood cancer: a call to action

All children with cancer deserve equal and equitable access to care and appropriate treatment, irrespective of gender, class, and geographical location. However, girls with cancer might be at a disadvantage to boys with cancer in parts of the world such as India, in which there is a disproportionately higher registration of cancer cases in boys than girls (sex ratio of 1·58:1). 1 Bhopal SS Mann KD Pearce MS Registration of cancer in girls remains lower than expected in countries with low/middle incomes and low female education rates. Br J Cancer. 2012; 107: 183-188 Crossref PubMed Scopus (12) Google Scholar The challenge of equity, however, begins even before children develop cancer. Starting at birth, large numbers of sex-selective abortions in some parts of India lead to skewed gender ratios in the general population. 2 Saikia N Meh C Ram U et al. Trends in missing females at birth in India from 1981 to 2016: analyses of 2·1 million birth histories in nationally representative surveys. Lancet Glob Health. 2021; 9: e813-e821 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar The biases against girls in India are often firmly entrenched in the sociocultural milieu, and extend to multiple aspects of health care. 3 Khera R Jain S Lodha R Ramakrishnan S Gender bias in child care and child health: global patterns. Arch Dis Child. 2014; 99: 369-374 Crossref PubMed Scopus (68) Google Scholar Consequently, there is a gender differential in infant and under-5 mortality. 4 Chowdhury R Taneja S Mazumder S Bhandari N Strand TA Gender differences in infant survival: a secondary data analysis in rural North India. BMJ Open. 2017; 7e014179 Google Scholar , 5 Patel P Kumar K Singh M Yadav AK Sex differentials in under five mortality in India in last two decades: evidence from pooled NFHS data. Child Youth Serv Rev. 2020; 118105286 Google Scholar Sex disparity in childhood cancer in India: a multi-centre, individual patient data analysisThe sex ratio for childhood cancer in India has a bias towards boys at the level of diagnosis, which is more pronounced in northern India and in situations demanding greater financial commitment. Addressing societal sex bias and enhancing affordable health care for girls should be pursued simultaneously in India. Full-Text PDF

Sex disparity in childhood cancer in India: a multi-centre, individual patient data analysis

Sex disparity and its determinants in childhood cancer in India remain unexplored, with scarce information available through summary statistics of cancer registries. This study analysed the degree of sex bias in childhood cancer in India and its clinical and demographical associations. In this retrospective, multicentre cohort study, we collected individual data of children (aged 0-19 years) with cancer extracted from the hospital-based records of three cancer centres in India between Jan 1, 2005, and Dec 31, 2019, and two population-based cancer registries (PBCRs; Delhi [between Jan 1, 2005, and Dec 31, 2014] and Madras Metropolitan Tumour Registry [between Jan 1, 2005, and Dec 31, 2017]). We extracted data on age, sex, and confirmed diagnosis of malignancy (according to the International Classification of Diseases-10 coding),and excluded participants if they were without a recorded diagnosis, had a benign diagnosis, had missing sex information, resided outside of India, or were a donor for haematopoietic stem cell transplantation (HSCT). The primary outcome was the male-to-female incidence rate ratio (MF-IRR) in the two PBCRs and the male-to-female ratios (MFR) from the hospital-based and the HSCT data. For PBCR data, MF-IRR was estimated by dividing the MFR by the total population at risk. MFR was analysed for patients seeking treatment at the cancer centres and for those undergoing HSCT. Logistic regression analyses were done to explore the association of clinical and demographical variables with sex of the patients seeking treatment and those undergoing HSCT in hospital-based data and multivariable analyses were done to determine independent sociodemographic predictors of sex bias. Annual time trends of MFR and MF-IRR during the 15-year study period were ascertained by time series regression analyses. We included 11 375 children from PBCRs in the study. 26 891 children from hospital-based records were screened, and data from 22 893 (85·1%) were included (including 514 who underwent HSCT). Residence details were missing for 257 (1·1%) of 22 893 patients from hospital-based records. The crude MFR of children at diagnosis was in favour of boys: 2·00 (95% CI 1·92-2·09) in the Delhi PBCR and 1·44 (1·32-1·57) in Madras Metropolitan Tumour Registry. The MF-IRRs for cancer diagnosis were also skewed in favour of boys in both PBCRs (Delhi 1·69 [95% CI 1·61-1·76]; Madras Metropolitan Tumour Registry 1·37 [1·26-1·49]). The MFR for children seeking treatment from hospital-based records was 2·06 (95% CI 2·00-2·12) in favour of boys. In subgroup analyses, the proportion of boys seeking treatment was higher in northern India than southern India (p<0·0001); in private centres than in centres providing subsidised treatment (p<0·0001); in patients with haematological malignancies than those with solid malignancies (p<0·0001); in those residing 100 km or further from the hospital than those within 100 km of a hospital (p<0·0001); and those living in rural areas than those living in urban areas (p=0·0006). The MFR of 514 children who underwent HSCT was 2·81 (95% CI 2·32-3·43) in favour of boys. Time trend analysis showed that MFR did not show any significant annual change in either the overall cohort or in any of the individual centres for hospital-based data; however, the analysis did show a declining MF-IRR in the Delhi PBCR from 2005 to 2014 (p=0·031). The sex ratio for childhood cancer in India has a bias towards boys at the level of diagnosis, which is more pronounced in northern India and in situations demanding greater financial commitment. Addressing societal sex bias and enhancing affordable health care for girls should be pursued simultaneously in India. None. For the Hindi translation of the abstract see Supplementary Materials section.

Adaptation of the Patient Reported Outcome Measurement Information System (PROMIS) tool for childhood cancer in India: A qualitative study.

To fill the gap in patient-reported outcome (PRO) assessment in children with cancer in India, we planned to adapt domains from the HealthMeasures Patient Reported Outcomes Measurement Information System (PROMIS) tool. This study attempted to identify and pool outcomes relevant to children with cancer and their caregivers in Northern India. The study was qualitative and conducted through focussed group discussions (FGDs) and in-depth interviews of children with cancer and their caregivers. Content analysis of transcripts from the sessions was done. The collected themes were collated with existing item banks of the PROMIS tool and new concepts unique to our population were compiled. A set of three FGDs and 14 interviews each for children and their caregivers were conducted. Following content analysis, 121 themes were identified including 10 new concepts. Themes pertaining to the physical domain were cited most. The theme distribution across the three domains was similar among children and caregivers. In the survivor cohort, the relative frequency of mention of psychological and social themes was higher compared to the whole cohort. Themes pertaining to mobility, cognitive dysfunction and peer relationships were more common among survivors. This qualitative study in children with cancer and their caregivers in India has facilitated a better understanding of the issues pertaining to cancer care that are of most importance to its stake holders. The themes collected may be used to formulate a PRO tool uniquely tailored for use in this population.

Trend of Childhood cancers in India: A review of Population based cancer registries data on Childhood cancers.

Trend of Childhood cancers in India: A review of Population based cancer registries data on Childhood cancers.

Gender disparity in childhood cancer in India: Should we think beyond neglect!!

Gender disparity in childhood cancer in India: Should we think beyond neglect!!

Estimated National and State Level Incidence of Childhood and Adolescent Cancer in India

Hitherto, incidence burden of childhood cancer in India has been derived from GLOBOCAN data. Recent analyses have challenged whether this accurately measures the true incidence of childhood cancer. To use observed data rather than simulation to estimate the number of children (0-14 years), as well as number of children and adolescents (0-19 years), in India who develop cancer every year at the national and state/union territory (UT) level. Age-specific (five year groups), sex-specific, and state/UT specific population data from India Census 2011 was used. Global average incidence rates from the International Incidence of Childhood Cancer 3 (IICC3) report were used. Incidence rates per million person-years for the 0-14 years and 0-19 years age groups were age-adjusted using the world standard population to provide age-standardized incidence rates, using the age-specific incidence rates for individual age groups (0-4 years, 5-9 years, 10-14 years, and 15-19 years). The national number of children (0-14 years) and, children and adolescents (0-19 years) that may develop cancer every year based on 2011 census are 52,366 and 76,805 persons respectively. Cancer type specific incidence is provided for each state/UT for these age ranges. This national incidence is approximately double of the GLOBOCAN 2018 estimates of incidence of children diagnosed and registered with cancer and the differential is greater in girls. Our analysis proposes new estimates of incident childhood cancer cases in India for children and adolescents. Future regional, national and international research on childhood cancer epidemiology and healthcare accessibility would help further refine these estimates.

Magnitude and Trends of Childhood Cancer in India

Magnitude and Trends of Childhood Cancer in India

Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage

BackgroundThere are multiple barriers impeding access to childhood cancer care in the Indian health system. Understanding what the barriers are, how various stakeholders perceive these barriers and what influences their perceptions are essential in improving access to care, thereby contributing towards achieving Universal Health Coverage (UHC). This study aims to explore the challenges for accessing childhood cancer care through health care provider perspectives in India.MethodsThis study was conducted in 7 tertiary cancer hospitals (3 public, 3 private and 1 charitable trust hospital) across Delhi and Hyderabad. We recruited 27 healthcare providers involved in childhood cancer care. Semi-structured interviews were audio recorded after obtaining informed consent. A thematic and inductive approach to content analysis was conducted and organised using NVivo 11 software.ResultsParticipants described a constellation of interconnected barriers to accessing care such as insufficient infrastructure and supportive care, patient knowledge and awareness, sociocultural beliefs, and weak referral pathways. However, these barriers were reflected upon differently based on participant perception through three key influences: 1) the type of hospital setting: public hospitals constituted more barriers such as patient navigation issues and inadequate health workforce, whereas charitable trust and private hospitals were better equipped to provide services. 2) the participant’s cadre: the nature of the participant’s role meant a different degree of exposure to the challenges families faced, where for example, social workers provided more in-depth accounts of barriers from their day-to-day interactions with families, compared to oncologists. 3) individual perceptions within cadres: regardless of the hospital setting or cadre, participants expressed individual varied opinions of barriers such as acceptance of delay and recognition of stakeholder accountabilities, where governance was a major issue. These influences alluded to not only tangible and structural barriers but also intangible barriers which are part of service provision and stakeholder relationships.ConclusionAlthough participants acknowledged that accessing childhood cancer care in India is limited by several barriers, perceptions of these barriers varied. Our findings illustrate that health care provider perceptions are shaped by their experiences, interests and standpoints, which are useful towards informing policy for childhood cancers within UHC.

Childhood cancer in India

India has made significant improvement in childhood cancer services in last few decades. However, the outcome still remains modest as compared to global standards due to significant barriers in recognition, diagnosis and cure.Data regarding comprehensive childhood cancer burden in country is lacking due to low and urban predominant coverage of population-based cancer registry programs. The available data shows lower incidence of childhood cancer incidence especially in leukaemia and CNS tumours which may suggest poor awareness of caregivers and delayed diagnosis with many “missed cases”. Incidence data are also skewed towards male preponderance which suggests gender bias in seeking healthcare.The childhood cancer services in India are predominantly restricted to few tertiary care centres in major cities. The outcome in major groups of cancer is complicated by delayed and more advanced stage of presentation and poor supportive care during intensive treatment. Treatment refusal and abandonment remains major hurdles.Last few decades saw development of dedicated paediatric oncology services and training programs in the country. The development of InPOG (Indian Paediatric Oncology group) for conducting collaborative trials will lead to adoption of uniform treatment protocols suited for the country. Financial support through the government promoted health insurance and holistic support through philanthropic organizations have improved treatment adherence and outcome.Moving forward, the focus should be on strengthening the cancer registries for capturing nationwide data, improving awareness of childhood cancer among caregivers and healthcare workers for early recognition and improving accessibility of childhood cancer care services beyond major cities.

A qualitative study of the costs experienced by caregivers of children being treated for cancer in New Delhi, India

AbstractBackgroundThe allocation of time and other resources is essential to enable the treatment of children with cancer. Evidence derived from high‐income countries showcases the significant costs families may incur impacting their finances and lifestyle. However, there is a paucity of research examining the costs of childhood cancer in India, which may impact families' decision to abandon their child's treatment.AimThe aim of this study was to explore the costs experiences by caregivers of children undergoing pediatric cancer treatment in New Delhi, India.MethodsA qualitative descriptive study was conducted in three cancer institutions in New Delhi. Semistructured interviews were conducted with caregivers of children with cancer in English or Hindi. Interviews were transcribed verbatim, translated into English, and analyzed using a thematic approach.ResultsIn total, 25 caregivers of 24 children diagnosed with cancer participated in the study. Caregivers described direct, indirect, and psychosocial costs associated with their child's treatment. The primary sources of direct costs were hospital admissions, medications, food, and travel expenses. Indirect costs involved managing their child's treatment, affecting caregivers' sleep, work hours, and time spent with other family members. Psychosocial costs included coping with the uncertainty caused by a cancer diagnosis, feelings of guilt, and sadness as well as having to watch their children suffer. Caregivers accessed a network of support to cope with their child's treatment. No families abandoned treatment or indicated that they intended to do so.ConclusionsThe results of this study provide avenues for health care professionals and institutions to develop interventions aimed at reducing the costs associated with cancer treatment. Further research into the relationship between various costs and treatment abandonment is needed.

Overall and Event Free Survival of Childhood Cancer in India in the 21st century: Report from a Hospital Based Cancer Registry

Overall and Event Free Survival of Childhood Cancer in India in the 21st century: Report from a Hospital Based Cancer Registry

Availability And Price Of Essential Medicines For Treating Childhood Cancers In India

Availability And Price Of Essential Medicines For Treating Childhood Cancers In India

Incidence and Pattern of Childhood Cancers in India: Findings from Population-based Cancer Registries.

Childhood cancers have different characteristics than those occurring among adults and described as cancers occurring below 15 years of age. In developed countries, its incidence is relatively rare but it's a leading cause of death. More than 80% of the childhood cancers are occurring in low and middle income countries. Based on data from population based cancer registries under National Cancer Registry Programme, in this commentary, we described the incidence and pattern of Childhood cancers in India and its implications.

Childhood Cancer Mortality in India: Direct Estimates From a Nationally Representative Survey of Childhood Deaths.

PurposeAlthough most children with cancer live in low- and middle-income countries, measurements of childhood cancer burden in such countries have been restricted to incidence rates from a few subnational cancer registries and mortality rates from vital statistics. We aimed to provide alternative burden estimates by using nationally representative longitudinal survey–derived mortality rates.MethodsWe examined cancer deaths in childhood (1 month to 14 years of age) in the Million Death Study, a cohort of > 27,000 pediatric deaths in India on the basis of enhanced verbal autopsies. All deaths potentially due to childhood cancer were identified. Two pediatric specialists independently categorized deaths as definite, probable, possible, or unlikely cancer related. From definite and probable deaths, we estimated national and regional mortality rates attributable to childhood malignancies. Data on symptoms and health care–seeking behavior were abstracted from closed-ended questions and caregiver narratives.ResultsOf 700 included deaths, 189 were classified as definite or possibly cancer related. The κ-statistic between reviewers was 0.75 (95% CI, 0.71 to 0.78). From these deaths, we estimated that in 2010, 13,700 were a result of childhood cancer in India, which led to a mortality rate of 37 (95% CI, 31 to 42) per million population per year, which exceeds many prior estimates of mortality and even some estimates of incidence. Disparities between mortality estimates were widest in northeast India and for brain tumors. A preponderance of male deaths was seen (male:female ratio, 1.6:1).ConclusionThe burden of childhood cancer in India is substantially higher than previously suggested. This information will aid advocacy for national strategies aimed at improving outcomes for Indian children with cancer.

Oral health of children with acute lymphoblastic leukemia: A review

Leukemia is a malignancy of the bone marrow and blood. It is the most common childhood cancer in India. Advances in the treatment regimens have greatly increased the chances of survival. Both the disease and its treatment change the oral environment. In some cases, oral manifestations are the presenting feature of the disease and it will be the dentist's responsibility to identify the underlying disorder and guide the diagnosis of the patient. Hence, the aim of present article is to review the literature concerning the oral health of children with acute lymphoblastic leukemia (ALL).

Human epidermal growth factor receptor 2 expression in gastric carcinoma and its association with histopathological parameters in Indian population.

Gastric carcinoma is a leading cause of death worldwide with a five year survival of 10-15% even after curative resection. Trastuzumab has emerged as a potential targeted therapy in treatment of Her 2 positive gastric cancer. Her2 positivity ranges from 7-34% in studies across the world. There is a paucity of Indian studies hence a need for determination of Her2 expression in Indian population for better patient management. This study was carried out to determine the frequency of Her 2 expression in gastric carcinoma by immunohistochemistry (IHC) technique and to evaluate its association with histopathological parameters. A total of 110 cases of gastric adenocarcinoma diagnosed on histopathological examination from July 2013 to June 2015 were included. Of these, 40 cases were resection specimens and 70 were biopsies. Histological typing of gastric carcinoma was done on the basis of Lauren classification. IHC for Her2 was done in all 110 cases. Her 2 expression was correlated with various histopathological parameters. Positive Her 2 expression (IHC 3+) was seen in 24.5% cases of gastric carcinoma. Patients in older age group(> 60 years) showed higher Her 2 positivity rate as compared to middle age (40-60 years) and younger population (<40 years). Higher percentage of Her 2 positivity was noted in male patients as compared to female patients. Her 2 positivity was seen more commonly in intestinal type of tumor as compared to diffuse and mixed types. Her 2 positivity was seen more in well differentiated carcinoma and higher stage tumors (pT3 and pT4). However, out of all, a statistically significant association of Her2 expression was found only with (intestinal) type of tumors (p= 0.005) and no significant association was seen with age, gender, site of tumor, tumor stage, lymph node status, lymphovascular, perineural and perinodal invasion or survival. Inspired by promising results of Trastuzumab therapy in Her 2 positive gastric carcinoma worldwide, it is recommended to routinely test all cases of gastric carcinoma for Her 2 expression and to use the targeted therapy with curative intentions in Indian population.

Specialist Pediatric Palliative Care Prescribing Practices: A Large 5-year Retrospective Audit.

Introduction:There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of prescribing practices of a specialist palliative care service situated in a tertiary cancer center.Methods:A total of 1135 medication records of children receiving specialist pediatric palliative care services were audited for 5 years (2010–2014) to evaluate prescribing practices in children with advanced cancer.Results:A total of 51 types of drugs were prescribed with an average of 4.2 drugs per prescription. 66.9% of the prescriptions had paracetamol, and 33.9% of the prescriptions had morphine. Most common nonsteroidal anti-inflammatory drugs prescribed was ibuprofen (23.9%), and more than 50% of the prescriptions had aperients. The most commonly prescribed aperient was a combination of liquid paraffin and sodium-picosulfate. Dexamethasone was prescribed in 51.9% of patients and in most cases this was part of oral chemotherapy regimen. Generic names in prescription were used only in 33% of cases, and adverse effects of the drugs were documented in only 9% of cases. In 25% of cases, noncompliance to the WHO prescription guidelines was seen, and patient compliance to prescription was seen in 40% of cases.Conclusions:Audit of the prescribing practices in specialist pediatric palliative care service shows that knowledge of pediatric palliative care formulary, rational drug use, dosing, and prescribing guidelines is essential for symptom control in children with advanced life-limiting illness. Noncompliance to WHO prescribing guidelines in one fourth of cases and using nongeneric names in two-thirds of prescription indicates poor prescribing practices and warrants prescriber education. Prescription noncompliance by almost two-thirds of patients is alarming and necessitates intense patient, family, and caregiver education and empowerment.

Pregnancy in Survivor of Acute Lymphoblastic Leukemia with Thalassemia Trait

Of all cancers in India, 1.6–4.8 % cancers occur in children less than 15 years of age [1]. Leukemia is the most common childhood cancer in India with the relative proportion varying between 25 and 40 %. 60–80 % percent of all leukemias are acute lymphoblastic leukemia (ALL). The five-year overall survival for ALL is 33 % [1].