Lack of awareness and treatment facilities are biggest challenges
Over the past two decades, great strides have been made in Africa in general and Rwanda in particular in the reduction of child mortality. This is mainly the result of improved neo-natal care and increased efforts to eradicate preventable diseases such as malaria, as well as wider access to health care.
A doctor attends to a young cancer patient in a Kampala hospital. (Internet photo)
However, as a result other causes of child deaths have become more prominent, one of the most worrying of which is pediatric cancer. That is why this type of disease was the focus of the annual child health conference held last week under the theme “Treat pediatric cancer for a healthy tomorrow.”
According to Prof. Cristina Stefan from the hematology and oncology department at Stellenbosch University, each year 175,000 children are diagnosed with cancer all over the world and 80% of children with cancer are found in countries with constraining financial conditions preventing proper care. “Childhood cancer is rare but it still represents 2 to 12% of all cancers,” she said.
An analysis of facility-based cancer registries in 2010 revealed a total of 2,476 cancer cases registered in Rwanda, among which 312 were children aged less than 18 years. And the cases of cancer in children have been increasing in recent years, as Dr. Lisine Tuyisenge, a pediatrician pointed out.
“A sensible decrease in other child diseases has been noted since 2006, but we have been receiving more cases of pediatric cancer,” she said. “Apart from neonatal related cases, pediatric cancer is now the first cause of hospitalization in two referral hospitals, namely the CHUK and CHUB. It is also one of the three leading causes of mortality in children.”
As with adult cancers, early detection improves the chances of full recovery. “The thing is that most of the types of cancer which affect children can be cured if diagnosed early and treated,” Stefan explained.
Some of the methods used for cancer detection and diagnosis are ultrasound guided core biopsies, chest x-ray, CT scans, surgical biopsies and pathology laboratory. “We do have a CT scan in CHUK and can perform biopsies,” Tuyisenge said. “The biopsies can also be sent to Boston for confirmation.”
Clear diagnosis is essential given that the treatment depends on the type of cancer the patient has. In Rwanda, the most common types of pediatric cancer detected so far are Hodgkin’s lymphoma (originating from white blood cells found in the liver and bone marrow among others), leukemia (cancer of the blood or bone marrow) and Wilms’ tumor (a type of kidney cancer), abdominal mass (any localized enlargement or swelling in the human abdomen) and brain tumor.
However, getting that early diagnosis is one of the main challenges. “The biggest problem is that we see the patients when they have reached an advanced stage,” Tuyisenge explained.
In addition, due to the high demand on the facilities that examine biopsies, it can take a long time to establish the diagnosis, and sometimes samples have to be sent to Boston for analysis. Thus it can take up to two months to get the results.
Availability of treatment facilities is another major problem. There are only three ways to treat cancer: surgery, chemotherapy and radiotherapy. “There is yet no radiotherapy available in the country as the installation of radiation equipment and other facilities is very expensive,” explained Dr. Larry Shulman, an oncologist working with the health ministry in the creation and implementation of national cancer strategy.
Surgery and chemotherapy are available, although that availability of drugs for chemotherapy is limited and is expensive. Unfortunately, in the treatment of malignant tumors surgery alone is never sufficient. “It’s just one of the challenges we face when it comes to cancer treatment,” disclosed Tuyisenge. “The fact of not having a stable team in oncology and no trained staff also complicates things.”
“The fact of not having a stable team in oncology and no trained staff also complicates things.”
In addition to these challenges, there is the problem of financial constraints to transport and get adequate nutrition for the patients. “The treatment usually requires the patient to come back regularly for follow-up,” explained Dr. Neo Tapela working with Partners in Health. “If they are coming from halfway across the country, it will be a big problem if the person cannot make it.”
Above all, however, the lack of awareness about cancer is the biggest hurdle. “Cancer is a reality and people need to be aware of this,” Tapela remarked.
In the fight against cancer, strong healthcare, infrastructure and qualified staff are key and strategies on how to approach all the other challenges. Among the steps that are to be taken is a national baseline training to improve the knowledge of nurses and doctors.
“We are also hoping to establish a pathology lab in Butare hospital,” Tapela said. “It will be set up as one of the national of the national cancer referral centers. This will enable us to make most diagnoses here without having to send them to Boston.”
As oncologist Stefan pointed out, “poverty and lack of infrastructure are a hindrance to the fight against pediatric cancer but when working together, what is impossible becomes possible.”