On the 15th of February every year, the world commemorates International Childhood Cancer Day to express support for children and adolescents with cancer, and for survivors and their families by raising awareness about cancer, and affirming the great need for collective global efforts to address the growing challenge of childhood cancer. The theme for 2021 was “Better survival” is achievable #ThroughOurHands. In commemoration of the day, the African Palliative Care Association hosted a webinar that brought together paediatric oncologists, oncology nurses, cancer survivors, community-based care workers, hospice and palliative care associations, and many other stakeholders from across Africa and beyond.
Dr Joyce Kambugu, a paediatric oncologist from the Uganda Cancer Institute, and also the representative of the International Society of Paediatric Oncology (SIOP) Africa, was one of the keynote speakers, who highlighted salient contextual issues concerning childhood cancer in Africa, one year into the COVID-19 pandemic.
But why the fuss about childhood cancer?
Citing the WHO Global Initiative for Childhood Cancer (GICC), Dr Kambugu said “Each year, 400,000 children and adolescents develop cancer worldwide, and 80% of these live in low- and middle-income countries (LMICs), almost 40% in Africa”. She went on to explain that statistics from 2015 show that only 60% of childhood cancer cases were diagnosed, suggesting that 40% are undiagnosed globally. However, it was important to note that childhood cancer is highly curable with currently available treatment approaches, and high-income countries expect up to 80% of children to be cured of cancer, but in low-income countries, survival is only about 20-30%. She underscored the substantial variation in survival rates by region, ranging from 3% in western Europe and North America to 57% in Western Africa. “In sub-Saharan Africa, it is estimated that fewer than half the expected cases are diagnosed; there is, therefore, poor survival in SSA (20 to 30%). This disparity was the basis of the 2018 WHO Global Initiative for Childhood Cancer resolution.
Childhood Cancer in Africa; Why does treatment fail?
According to the SIOP, half of all cancers in the 0 to 19-year age can be treated if diagnosed early & treated appropriately. So why does treatment fail? Here are the key reasons;
- Failure to diagnose or misdiagnosis
- Delayed presentation or diagnosis
- Unaffordable or abandoned treatment
- Treatment-related death
- Drug shortages and use of poor-quality medicines
- Lack of consistent adherence to treatment
- Use of reduced-intensity treatment regimens to facilitate tolerability and hence treatment failure and excess relapse
COVID-19 and Childhood Cancer in Africa
Although it has been established that children are at low risk for COVID-19 susceptibility and complications, many more children have been indirect casualties because of the public health and social distancing measures put in place to curb the spread of the disease. For instance, closure of schools resulted in children being unsupervised for prolonged periods of time and compromising Africa’s children formal learning, loss of family income left parents struggling to care for their children and make ends meet, and movement to treatment centres was halted, thereby disrupting routine health services such as immunization. The pandemic has thus presented a far-reaching secondary impact that has heightened risks to African children’s rights and wellbeing including health and safety/protection, particularly for girls. The pandemic unfolded against the backdrop of worrying hunger levels driven by climate change, conflict, economic challenges, and health systems that were already overburdened and under-resourced African across most of the continent. Thus, the COVID-19 pandemic has exacerbated existing vulnerabilities and had a catastrophic impact on the most vulnerable who do not have access to social protection systems, including the most vulnerable children. It threatens to reverse much development progress in Africa.
COVID-19 and effect on childhood cancer treatment
Two cross-sectional multicentre studies were carried out to establish the effect of COVID-19 on childhood cancer services in Africa, with paediatric oncologists as the key respondents. They all concurred on the overall deleterious effect of the pandemic on childhood cancer services, including;
- Modified chemotherapy regimens secondary to drug shortages
- Delays in surgery and radiotherapy due to movement restrictions
- Shortages of blood products
- Interruptions of medication supplies
- Reduced acceptance of new patients
COVID-19 and paediatric palliative care services in Africa
Whilst there were no specific studies on the effect of the COVID-19 pandemic on paediatric palliative care services in Africa, it can be surmised from the available information that there was increased difficulty in accessing palliative care services for all children including those already under palliative care and that delays in diagnosis contributed to advanced disease presentation where the only option for treatment was palliative care.
COVID-19 and paediatric palliative care services in China
In comparison, inferences can be made from this study carried out in China, where the pandemic resulted in a negative impact on palliative care service for inpatient, outpatient, and home visited patients. It also led to significant delays in access care, in some cases complete failure to access care, isolation of children from family, suspension of home visits, and the heightened risk of health workers getting infected.
What can we do?
Dr Kambugu concluded her address with a call to African governments and all other responsible authorities, on behalf of SIOP, the global professional body uniting all types of health care professionals involved in childhood cancer care, training and research, and the African Paediatric Oncology Community;
African Health Ministries must commit resources and effort towards ensuring that the GICC aim of reaching at least a 60% survival rate for children in Africa is reached. This will take deliberate efforts to;
- establish or support national childhood cancer registries for accurate data and planning of childhood cancer services,
- ensure primary health workers have the capacity to recognise signs of childhood cancer, refer timeously and appropriately, e
- Ensure appropriate and affordable medicines and devices are available to treat young people with cancer,
- ensure health care workers have palliative care competencies to alleviate all forms of suffering for children with cancer and their families,
- establish centres where children with cancer can be treated with dignity to the best medical standards,
- have robust research programmes for improvement and documentation of standards of care,
- improve the quality of survivorship and affordability of comprehensive cancer care through collaborations with communities, the private sector, etc.
Every African child with cancer deserves a chance; care for all, cure for more!