Paediatric cancer is a significant global health challenge, with India reporting approximately 50,000 cases annually. Despite advancements in paediatric oncology treatment, India continues to grapple with obstacles such as a lack of early diagnosis, limited access to care, diagnosis at advanced stages and challenges in completing treatment (high treatment abandonment rates). Dr Gauri Kapoor, Director and Head of Department of Pediatric Hematology – Oncology, Rajiv Gandhi Cancer Institute & Research Centre, shares her insights.
Leukaemia represents the most common form of cancer among children in India, accounting for nearly half of all cases in the 0-4 and 5-9 age groups. Lymphoid leukaemia, primarily acute lymphoblastic leukaemia, are the most prevalent type. Lymphomas are the second most common paediatric cancer. In the 0-19 age group, the four leading cancers are leukaemia, lymphoma, bone tumours, and central nervous system tumours.
Early detection, accurate diagnosis and proper treatment are hence critical to improving survival rates among children with cancer. Advancements in diagnostic imaging technologies like MRI and PET scans have significantly enhanced the ability of paediatric oncologists to precisely identify and monitor tumours. Additionally, the emergence of liquid biopsy techniques, which analyse blood samples for cancer-related biomarkers, is transforming the diagnosis and monitoring of paediatric cancers. These minimally invasive procedures are providing real-time insights into tumour genetics, enabling oncologists to make informed treatment decisions.
However, the first step towards early detection and diagnosis needs to be taken by the family and primary care physician. If a child exhibits prolonged persistent fever, paleness of skin, lethargy, unexplained bleeding (e.g., in urine), easy bruising, or a rash of small red spots, parents should seek immediate medical attention. The delay in diagnosis is a significant challenge in India, where many potentially curable cancers are missed at the early state. The primary care physicians also need to be sensitised to the early signs and symptoms of cancer in children.
People today need to understand that cancer treatment is no more like the traditional days. There are huge advancements, especially, personalized medicine, which has been a game-changer in paediatric oncology. It tailors treatments to the unique genetic and molecular profile of a child’s cancer.
Targeted therapies and immunotherapies, like CAR-T cell therapy, have revolutionized the treatment of aggressive paediatric leukaemia and lymphomas, providing hope for patients who have not responded to conventional treatments. A variety of paediatric cancers are being treated using immunotherapies, which have shown encouraging outcomes in the treatment of haematologic malignancies as well as solid tumours. They also have the added advantage of having less harmful side effects.
Advancements in treatment approaches are also improving outcomes for young patients. Less intensive chemotherapy regimens and innovative drug delivery systems, such as liposomal drug delivery, are reducing the treatment burden. Liposomal drug delivery systems are encapsulating chemotherapy drugs in tiny, fat-like particles, targeting cancer cells while minimizing damage to healthy tissue. These innovations are enabling children to receive effective treatment with fewer complications and a better overall quality of life.
Usually, childhood cancer survivors face long-term challenges, including secondary cancers, heart problems, cognitive impairments, and infertility. Paediatric oncologists are actively working to develop treatments that are both effective and less toxic. Proton therapy, a type of radiation treatment, is one such approach. Unlike traditional radiation, which can damage surrounding healthy tissue, proton therapy precisely targets the tumour, minimizing exposure to nearby organs and reducing the risk of long-term side effects. This is especially crucial for paediatric patients, whose developing bodies are more vulnerable to the harmful effects of radiation.
Thus, along with the addition to advancing paediatric oncology treatments, oncologists are focused on improving long-term outcomes for patients, minimizing the impact of treatment side effects. The Indian National Paediatric Oncology Group has been recently established with this goal in mind. This initiative brings together paediatric oncology units from across India to conduct regionally relevant research, including multicentre clinical trials. By generating evidence specific to the Indian population, the group aims to address the unique challenges of childhood cancer in India and improve patient outcomes. Through this collaborative effort, researchers hope to gain insights into the distinct characteristics of childhood cancer in India and develop more effective treatment strategies.
Today, paediatric oncologists also understand that cancer treatment for children extends beyond the physical disease, encompassing emotional and psychological support for both patients and their families. There are innovations in supportive care, such as psychological counselling, art and music therapy, and palliative services, crucially helping families cope with the challenges of cancer. Additionally, telemedicine and digital health tools have made it easier for families, especially those far from specialized centres to access support and stay connected with healthcare teams throughout the treatment journey.
The field of paediatric oncology is rapidly evolving, with new discoveries and innovations continually emerging. As research advances, the focus is increasingly shifting towards understanding the underlying causes of paediatric cancers, developing more effective and less toxic treatments, and improving the overall quality of life for young patients.
