Chapters authored
Patterns of Care of Childhood Cancers in India
Management of childhood cancers in India has seen a new high in last few decades due to collaborative efforts of Physicians and organizations- both governmental and non-governmental. However, care is still heterogenous in this vast country. The problems span from a lack of data to programs for tackling cancers at the community level and lack of awareness among parents and physicians on childhood cancers, along with a nihilistic attitude and stigma attached to cancers even in this digital era. In this article, we describe the milestones in the development of Pediatric Oncology as a specialty, of cancer registries, of diagnostic armamentarium, access to affordable drugs, and, palliative care for children with cancers in India, that perhaps reflects care in other developing countries.
Part of the book: Central Nervous System Tumors
Clinical Profile, Patterns of Care and Outcomes of Childhood CNS Tumours in India
Paediatric CNS tumours are the third most common childhood malignancy in India. They account for 14% of all cancers in the 1–14 years age group. There is dearth of adequate prospective or retrospective studies about patterns of care and outcomes. There is male preponderance. Primitive Neuro-ectodermal tumours (PNET) are the most common histology followed by astrocytoma and other gliomas among children from 0 to 19 years. Surgery, radiotherapy, and chemotherapy are the main modalities of treatment. Available data points to underutilisation of radiotherapy in clinical practice due to the fear of non-compliance. Paediatric CNS tumours outcomes are different from adult brain tumours due to their aggressive histology, variable clinical presentations, delay in diagnosis, etc. There is also shortage of adequate multidisciplinary paediatric neuro-oncology units in the country. Future directions include setting up more dedicated paediatric neuro-oncology units, implementation of new 2022 WHO classification by adopting molecular testing across different histology’s, use of better radiation technology to prevent long term neurocognitive and other late effects and survivorship clinics to monitor for late effects and rehabilitate the childhood cancer survivors and, perhaps a registry. These issues are discussed in detail in this chapter.
Part of the book: Central Nervous System Tumors