CHILDHOOD CANCER – HOW TO SUPPORT THE YOUNG WARRIORS-Report

SWASTH MITRA – Webinar

DATE: Saturday 18 May 2024 TIME 11:00 am to 12:00 pm

 

About Dr. Rasmi Palassery

Dr Rasmi is a children’s cancer, blood disorders and bone marrow transplant specialist. She did her M.B.B.S from Govt. Medical College Thrissur, Kerala, followed by a 3 year residency in Pediatrics from Texas Tech University, Amarillo, USA where she was also the Chief Resident. She went on to do a 3 year fellowship in Pediatric Hematology/Oncology from Rainbow Babies and Children’s Hospital, Cleveland, USA, where she gained expertise in the treatment of pediatric cancers, benign blood disorders, stem cell transplantation and research trials

Her research in developing methods to enhance stem cell engraftment after a bone marrow transplant, funded by an institutional grant was presented at the ASPHO 2015 conference in Phoenix, AZ, USA. She joined the Department of Medical Oncology at Ramaiah Medical College in 2016, where she continues as a faculty.

Dr Rasmi’s clinical interests include malignancies and benign blood disorders in children and young adults. She is trained in performing hematopoietic stem cell transplant for malignant conditions as well as benign blood disorders and immunodeficiency. Her research interests are epidemiological studies and quality improvement projects focusing on adolescent and young adult cancer and bone marrow transplant patients.

She is part of the CHBMT blood and marrow transplant program at Ramaiah Medical College which became the first medical college in Karnataka to complete 100 HSCTs in January 2022. She has co-authored articles in various peer reviewed journals and presented abstracts at various scientific society meetings nationally and internationally. In her institute, she works with various charities and organisations to provide financial assistance to children with cancers and blood disorders.

She is the chair of the task force on ‘Information, Awareness and Engagement’ at the Indian Childhood Cancer Initiative (ICCi) and a member of the global advisory board for Together by St. Jude’s

She is also a trained Bharatnatyam dancer and an avid literature enthusiast.

Report:

Dr Rasmi started the session with talking about what is cancer- a collection of related diseases. Cancer starts in one part of body where cells start multiply uncontrollably. A global initiative was launched few years ago by WHO, where all the children in the world should get the treatment

She went on and explained about Metastasis where some cancer cells can break off and travel to distant places in the body. It may spread through blood or lymph system. It forms new tumors far from the original one.

So, what causes cancer? It is a genetic disease, each cell has nucleus, we have chromosomes, and which has master program for your body. It decides what is going to have in the body. So how genetic changes happen? Mutation of error in the gene, stops them becoming normal cell. This can be inherited from parents by birth too.

Mutation can happen due to tobacco, radiations, plastic, environmental pollution- eventually results in cancer.

Age is also concern as body’s ability to fix the error becomes less. Other causes can be diet, obesity, chronic infections, which may boost cancer. People think that cancer cases has increased but more diagnosis is happening. Few years back reporting was not so good. There are 19.3 million cancer cases worldwide and India is third after China and US and has 57.5% cases of all. More than 1300 people die every day in India due to cancer and the mortality rate increased in past few years by 6% which is predicted to grow more. Adults are more likely to have.

Cancer in Children in adolescents is rare but it is slowly increasing since year 1975.Good news is, Paediatric Cancer death rates have declined by 70% over the past 4 decades. 70-90% childhood cncer is curable in the Western World due to better response to the treatment, Standardized protocls and supportive care. Still 1000 children die annually from the disease.

Childhood Cancer Scenario in India:

9th Common cause for the deaths between 5-14 yrs of age.

Nearly 20-50 thousand new childhood cancer cases / year. Now close to 1 lac / year.

75% of children die due to lack of awareness, late detection, inadequate treatment facilities and increasing cost of treatment and lack of supportive care.

Cases of Childhood Cancer:

Most childhood cancer causes are not known. About 5% are caused by inherited mutation. It is difficult to determine what children might have been exposed to early in their developemnet. Most common is blood cancer in child.

Common Signs of Childhood Cancer :

• Feeling very tired / pale skin
• Persistent infections such as ear, throat and chest
• Flu like symptoms that don’t go away
• Blood in urine, poo or when sick
• Bruising easily or small red spots.
• Sweating or fever specially at night.
• Bones, joints ache that don’t go away and get worst at nights.
• Unexplained limb and leg weakness.
• Constipation, Lump swelling or unusual firmness anywhere on the body.
• Eye changes – white glow.
• Weight loss or slow growth
• Changes in mole size or colour
• Persistent crying and screaming in young children.
• Brain tumours cases headache, dizziness, seizures, clumsiness, off balance etc.

Treatment is similar to adults – surgery, chemotherapy, radiation, immunotherapy, targeted therapy, hormone therapy and stem cell transplant. The survival rate for childhood leukaemia is 80-85%.

Doctor spoke in detail about each type of cancer in children and their treatment. Bone cancers in kids are metastatic and survival chances falls hence early diagnosis is very important

Late effects of cancer treatment is unique for childhood cancer. Health problems can develop months or years after cancer treatment and can last many years, like changes in neuro-cognition, hearing, vision, hormonal change s- growth, puberty, reproductive concerns, risk of developing secondary cancers.

Living with cancer as a child can be difficult. Associated with lots of discomfort. They depend on elders, docs, parents for conform and understanding the truth. They understand concept, so answer the curiosity appropriately. Better to be honest and talk to them.

Doctor also discussed the sibling perspective where they do not know how to cope up with changes in the family, what to say when friends ask tough question and what is chemo, radiation. They need to know how to face, gossips of people around. Prepare them to answer people’s question.

Secondly, doctor discussed the parents’ perspective – let family, friends know about it and how they can help.

India is improving with better treatment, supportive care, survival care and re integrating them to normal life, focusing on the late development. However, there is room for improvement in better supportive care and health care policy should be taken care. They must be aware of the implications.

Cancer Prevention:

Way to avoid things known to cause cancer.

Change in diet and lifestyle.

Finding precancerous conditions early.

Chemoprevention (medicines to treat precancerous condition or to keep cancer from starting)

Dr Rasmi conclude the session with some take home points:

• Children do get cancer, it is rare but it is there.
• Majority of the time it is curable if detected on time treated.

Early detection and proper treatment are the key.