Small steps towards bigger goals: A study of demography and outcome of paediatric cancers in a peripheral resource limited paediatric oncology centre
Keywords:Event free survival, Overall survival, Outcome, Epidemiology of paediatric cancers
Background: The aim of this study was to analyze the demography, clinical profile and outcome of pediatric cancer cases from a peripheral resource limited center.
Methods: We retrospectively analysed demography, clinical details and outcomes of 227 cases of paediatric cancer up to nineteen years of age, from August 2009 to May 2019. Their status of treatment was categorised as completed, ongoing, abandoned and expired. We generated Kaplan-Meier curves (KM) and calculated three-year event free survival (EFS) and overall survival (OS).
Results: Out of 227 children, 139 (61.2%) were boys and the rest were girls. Maximum number of children 108 (47.6%) were aged zero to four years. The socioeconomic status of 70 patients using the Kuppuswammy scale showed that 55 patients (78.57%) belonged to a lower socio-economic stratum. The commonest malignancy was leukaemia 119(52.4%) followed by solid tumours constituting 84 (37%) patients, of which 25 (11.01%) were renal tumours. Out of total 227 patients, 107 (47.13%) have completed treatment, 45 (19.8%) were on treatment, 24 (10.6%) have abandoned and 51 (22.5%) had expired. The median duration of follow up was 18 months. The three-year EFS and OS were 71.9% and 74.8% respectively for the entire COHORT, 74.4% and 75.5% for ALL (Acute Lymphocytic Leukemia), 38.4% and 46.1% for AML (Acute Myeloid Leukemia) and 74.3% and 76.6% for solid tumours. Among solid tumours, three-year EFS and OS was of renal tumours 86.9% and of neuroblastoma was 77.7%.
Conclusions: We achieved outcomes similar to those from well-established Indian single institute studies. The survival of our paediatric cancer patients can be improved with collaborative effort and establishment of new centres in the periphery.
Consolidated Report of Population Based Cancer Registries 2001-2004. National Cancer Registry Programme, Indian Council of Medical Research, Bangalore, India, Dec 2006. Available at: https://www.ncdirindia.org/All_Reports/PBCR_2001_04/PBCR_2001_04.pdf. Accessed on 28 June 2021.
First Report of the Population Based Cancer Registries Under North Eastern Regional Cancer Registry 2003-2004. National Cancer Registry Programme, Indian Council of Medical Research, Bangalore, India, Sep 2006. Available at: https://www.ncdirindia.org/All_Reports/PBCRNE_2003_04/PBCRNE_2003_04.pdf. Accessed on 28 June 2021.
Arora B, Kanwar V. Childhood cancers in India: Burden, barriers, and breakthroughs. Indian J Cancer. 2009;46(4):257-9.
Arora RS, Eden T, Kapoor G. Epidemiology of childhood cancer in India. Indian J Cancer. 2009;46(4):264-73.
Gurney JG, Bondy ML. Epidemiology of childhood cancer. In: Pizzo PA, Poplack DG, eds. Priciples and Practice of Pediatric Oncology. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006: 2-14.
Arora B, Kurkure P, Parikh P. Childhood cancers: Perspectives in India. J Indian Med Assoc. 2005;103(9):479-82.
Kuppuswamy B. Manual of socioeconomic status (urban). 1st ed. Delhi: Manasayan; 1981: 66-72.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clinic. 2018;68:7-30.
National Cancer Institute. SEER Cancer Statistics Review, 1975-2015. Available at: https://seer.cancer.gov/csr/1975_2015/. Accessed on 28 June 2021.
Nandakumar A, Anantha N, Kumaraswami A, Appaji L, Mukherjee, G, Venugopal T, et al. Descriptive epidemiology of childhood cancers in Bangalore, India. Cancer Causes Control. 1996;7:405-10.
Tyagi BB, Manoharan N, Raina V. Childhood cancer incidence in Delhi, 1996-2000. Indian J Med Paed Oncol. 2006;27:13-8.
Swaminathan R, Rama R, Shanta V. Childhood cancers in Chennai, India, 1990-2001: incidence and survival. Int J Cancer. 2008;122(11):2607-11.
Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62(4):220-41.
Arora B, Banavali SD. Pediatric oncology in India: Past, present and future. Indian J Med Paediatr Oncol. 2009;30(4):121-3.
Magrath I, Shanta V, Advani S, Adde M, Arya LS, Banavali S, et al. Treatment of acute lymphoblastic leukaemia in countries with limited resources; lessons from use of a single protocol in India over a twenty-year period. Eur J Cancer. 2005;41(11):1570-83.
Möricke A, Zimmermann M, Reiter A, et al. Long-term results of five consecutive trials in childhood acute lymphoblastic leukaemia performed by the ALL-BFM study group from 1981 to 2000. Leukemia. 2010;24(2):265-84.
Trehan A, Singla S, Marwaha RK, Bansal D, Srinivasan R. Hodgkin lymphoma in children: experience in a tertiary care centre in India. J Pediatr Hematol Oncol. 2013;35(3):174-9.
John R, Kurian JJ, Sen S, Gupta MK, Jehangir S, Mathew LG, et al. Clinical outcomes of children with Wilms tumor treated on a SIOP WT 2001 protocol in a tertiary care hospital in south India. J Pediatr Urol. 2018;14(6):547-51.
Meena JP, Gupta AK, Parihar M, Seth R. Clinical profile and outcomes of Non-Hodgkin's lymphoma in children: a report from a tertiary care hospital from India. Indian J Med Paediatr Oncol. 2019;40(1):41.
Radhakrishnan V, Raja A, Dhanushkodi M, Ganesan TS, Selvaluxmy G, Sagar TG. Real world experience of treating neuroblastoma: experience from a tertiary cancer centre in India. Indian J Pediatr. 2019;86(5):417-26.
Radhakrishnan V, Thampy C, Ganesan P, Rajendranath R, Ganesan TS, Rajalekshmy KR, et al. Acute myeloid leukemia in children: experience from tertiary cancer centre in India. Indian J Hematol Blood Transfus. 2016;32(3):257-61.
Friedrich P, Lam CG, Itriago E, Perez R, Ribeiro RC, Arora RS. Magnitude of treatment abandonment in childhood cancer. PloS One. 2015;10(9).