A situational analysis of childhood cancer care in India has found that services are concentrated at the tertiary level, and there are gaps in the availability of specialised paediatric oncology care in all tertiary hospitals. Additionally, the availability of childhood cancer care services is higher in private and NGO-managed hospitals than in public hospitals.
The survey titled ‘An assessment of childhood cancer care services in India — gaps, challenges and the way forward’, has been published in The Lancet, Regional Health — South-East Asia.
The survey highlights the need to integrate childhood cancer care as a part of the national cancer control response as a matter of priority. “The need of the hour is to formulate a childhood cancer policy that will enable timely access to care universally,’‘ the survey states.
The survey notes that dedicated paediatric oncology departments are available at 41.6% of the publicly managed tertiary-level hospitals; 48.6% of the privately managed tertiary-level hospitals; and 64% of the NGO-managed tertiary-level hospitals. In 36 (39%) of the 92 hospitals providing secondary care, childhood cancer care is provided.
The availability of bone scans (41.5%) and positron emission tomography (PET) scans (25.9%) was lower in public tertiary hospitals, whereas fewer histopathology, computerised tomography (CT), and magnetic resonance imaging (MRI) scanning facilities were available in public secondary hospitals than private and NGO-managed hospitals for the corresponding level of care.
Most tertiary hospitals had the required supportive care facilities, except for play therapy and hospice care.
The survey also found that less than 50% of the public tertiary hospitals had stocks of the four categories of cancer-treating drugs, and essential infrastructure for radiotherapy and chemotherapy. Most secondary-level hospitals not treating childhood cancer had referral linkages with tertiary hospitals.
The survey was conducted at 137 tertiary-level and 92 secondary-level hospitals in 26 States and four Union Territories, ensuring the uniform representation of public and private care hospitals.
The survey notes that according to a recent National Cancer Registry Programme (NCRP) report in India, childhood cancers in the 0–14 years age group accounted for 4% of all cancers.
The Population Based Cancer Registry in Delhi has reported the highest age-adjusted incidence rate (AAR) of 203.1 per million in boys and 125.4 per million in girls. Cancers of the eye and lymphoid leukaemia contributed to the highest disability-adjusted life years (DALY) in 2016 among children in the 0-14 years age group.
“The Ministry of Health and Family Welfare, Government of India, has been striving to achieve cancer control by implementing the National Programme for Prevention and Control of Non Communicable Diseases (NP-NCD). However, the country does not have a specific programme component or policy to address childhood cancer. There is limited information on the status, distribution, and quality of childhood cancer care services in India. Most studies have been done in selected geographic settings and do not provide a comprehensive country presentation,” the survey states.
The survey describes the cross-sectional survey results on the status of childhood cancer care services available at secondary and tertiary-level hospitals in India, and states that developing a programme component or policy for childhood cancers requires a situational analysis of childhood cancer services.
The study tool collected data on the organisational infrastructure, type of oncology services, health workforce, equipment, treatment and referral protocols, and treatment guidelines.
Descriptive statistics was used to primarily present the health service status and data on childhood cancer care services in proportions and mean. The World Health Organization (WHO) in India funded and provided technical support for the survey.
