Relentless effort towards improving childhood cancer care: Need of the hour.

It is with great pride that our journal is introducing the pediatric section, starting this issue onwards. In recent times, there has been growing awareness about the treatment of childhood cancer in the South Asian region and many success stories have come forth, which is encouraging.

It is known that in resource scarce countries we pediatric oncologists, pediatric oncosurgeons, and other multispecialty specialists dealing with pediatric oncology have to put in extra effort to achieve the results comparable to western countries.

In this introductory section, we are fortunate to have two interesting articles from pediatric oncologists, hailing from very different backgrounds. They share their insights which practicing pediatric oncologists will not only find extremely useful, but also inspiring.

In the first article, Dr. Lawrence Faulkner, Pediatric Oncologist shares his experiences on setting up excellent low cost bone marrow transplant units in Pakistan, through the Foundation cure2children (www.cure2children.org).[1]

In these transplant centers, they have treated patients with hemoglobinopathies mainly thalassemia, severe aplastic anemia, Fanconi's anemia, and acute lymphoblastic leukemia. It is estimated that thalassemia is one of the most common monogenetic disorder with a high incidence in the Asian subcontinent.[2] In this region, very few countries have dedicated national programs to manage the disease. This leads to poor outcomes and high morbidity among thalassemic patients. Transplant is the only curative option that relieves thalassemics from lifelong transfusions and needless to say from the various hazards associated with blood transfusions including iron overload.

The success of the low cost center with disease free survival of 92% is comparable to the results of any good transplant center in the West. The highlight of this article is meticulous and detailed preparation of the protocol. They have minimized the investigations by performing only necessary and pertinent monitoring during and after transplant, followed strict hand washing, and easily implementable cost-effective aseptic precautions. They have not used HEPA (high efficiency particulate air filters) and have successfully controlled the infection rate. As mentioned by the author, average cost of transplant was approximately 10,000 USD that is 10-20 times lower than in any developed nation with comparable survival results.

This article addresses the need of the hour, which is the needed to improve the standards of treatment offered to children in low and middle-income countries.

In the second article, Dr. Sadruddin and Dr. Hameed-ur-Rehman address a very important aspect of childhood cancer, that is, understanding the psychosocial impact of cancer diagnosis and treatment on the child through their drawings.[3]

The improvement in childhood cancer survival rates and increasing number of long term survivors has led to rapid development of interest in the psychosocial impact of diagnosis and treatment on a child with cancer. It is an issue of concern as many children, after the completion of treatment, face difficulty in coping with their day-to-day life. This negative psychosocial impact on the child's mind begins at diagnosis; and is contributed by innumerable painful procedures, side effects of chemotherapy, and feeling of burden on their families.[4]

In this article, it is appalling to see these children suffering during their treatment. Cancer therapy had a great negative impact on majority of them. Many of them developed negative self-perceptions that played a detrimental role in the development of their relationships with peers and siblings.

The children undergoing modern cancer therapy are long-term survivors. The poor self-perception and feeling of detachment with parents prevents them from functioning as normal adult individuals, thus failing to be productive in society.[2] As mentioned in the article by Sadruddin and Hameed-ur-Rehman, the active participation of the play therapist, social workers, doctors, and nurse physicians will help in allaying their anxiety and decrease the negative self-perception. This article emphasizes the need for a holistic approach towards the treatment of childhood cancer in order to obtain optimal results and functional healthy survivors.

We hope you find both articles useful and welcome your suggestions for this section. We also look forward to your contributions that are unique and researched and will benefit everyone in the battle against childhood cancer.