Comprehensive Cancer Care

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Information about Comprehensive Cancer Care

Published on January 12, 2009

Author: aSGuest10184


Comprehensive Care in Pediatric Cancer Patients : Comprehensive Care in Pediatric Cancer Patients Dr. Salah S. Abdel Hadi Professor, Pediatric Oncology NCI, Egypt Introduction : Introduction Cancer in children & adolescents is rare. Children & adolescents with cancer should be referred to tertiary care centers where multi-disciplinary care is available. Treatment, supportive care & rehabilitation are offered to achieve: a) optimal survival. b) quality of life Introduction : Introduction Pediatric cancer management is one of the success stories of modern medicine. The success of medical treatment of childhood cancer has significant public health impact when considered in terms of person years of potential life saved. There is a life time saved for every child cured of cancer. Introduction : Introduction Cancer in children is a significant problem of mortality in developed countries. Cancer is second cause of childhood death in US among 1 to 14 year olds (following accidents and preceding congenital anomalies and homicide). In developing countries, cancer trails infections as a cause of mortality; but continues to rise within list of priorities as infections become controlled. Introduction : Introduction Malignancies in childhood occur with an incidence of 13-14 per 100,000 children. Of the world’s population of 6 billion, 650 million reside in developed countries with older populations/smaller fraction of children. The number of new cases annually exceeds 200,000 world wide. The proportion of new cases in developing countries currently at about 85% and rising. Introduction : Introduction The population of developing countries represented 78% of the global total in 1990. Countries with limited resources accounted for 86% of the world’s children in 1990. “Projected to increase to more than 90% by 2030”. The major killers of children in countries with limited resources remain: a) infections b)malnutrition c)diarrhea/dehydration. Introduction : Introduction However there is an increase in the relative importance of cancer in the spectrum of disease in childhood in some developing countries. In China, cancer is now the most common cause of disease related death in school aged children. With future improvements in standard of living, success of immunization programs and disseminating medical services, childhood cancer will emerge as a major cause of death in children in developing countries Priority of Oncology Problem In Egypt : Priority of Oncology Problem In Egypt Pediatric oncology on the rise. Control of acute illnesses in pediatrics. Success of vaccination program. Population increase (1.8million births/year). Better diagnostic facilities & know how. Improving patient survival. Increasing specialized care centers. Outlets for Pediatric Oncology Service In Egypt : Outlets for Pediatric Oncology Service In Egypt Universities (14 governmental & private) Departments of pediatrics: liquid malignancies Departments of radiation oncology: solid tumors Cancer institutes National cancer institute, Cairo University South Egypt Cancer Institute, Assiut University Ministry of Health Nasser Institute Cancer Centers Armed Forces and Police hospitals Private Sector Background : Background Chemotherapy was introduced to treat childhood leukemia in 1940s. Prognosis of childhood cancer dramatically improved over the years. 5 year survival (diseases uniformly fatal in chemotherapy era) = 75% for all childhood cancer diagnosed between 1989 and 1995. Multi modality approach becomes standard in managing most childhood cancers. Principles : Principles Pharmacologic interventions in most cases “anti-hypertensives” administered with intent of controlling disease/symptoms rather than cure. Exception lies in anti microbial and anti cancer chemotherapy. The model for curing cancer is based on successful model of curing bacterial infections. Principles (cont.) : Principles (cont.) The strategy exploits differences between cancer and normal cells attempting to eradicate or kill cancer cells. Anti-cancer drug discovery relied on screening to evaluate anti-proliferative or cancer cell killing effects of drugs on tumor cell lines invitro. This method identified drugs that are cytotoxic and non selective. Most conventional anti-cancer drugs produce substantial clinical toxicity. Management : Management Protocol treatment Tumor boards Referral attitudes (tertiary care center) Team approach First chance is best chance and only chance of cure. Protocol Approach : Protocol Approach Patients treated on protocol do better than individually managed. Thesis approach vs. protocol approach The Indian experience Controversies of unifying protocols Upgrading of participating centers Development of two protocols Referral of patients during intensive management. Team Approach : Team Approach Shift from: - unipolar (doctor, leader & remaining followers) to - multipolar (teams of specialized professionals working in harmony) Development of trained professionals in: a) data management b) infection control, c) terminal care Infection Control : Infection Control Education fever/neutropenia - vaccinations Nosocomial infections infection control committees micro biological surveys Hepatitis national level hepato toxic agents management slip ups Compliance : Compliance Education: child - society family - medical milieu. Team approach doctor - clinical pharmacist nurse - dietitian social worker - play therapist Proper/practical dealing of - fears - mis-concepts. Late Sequelae : Late Sequelae Proper choice of chemotherapy: Agents protocols Avoidance of management by combined chemo/radiotherapy. Avoidance of radiation therapy in early childhood “deferred rth. in brain tumors” Avoidance of mutilative surgery Early and aggressive rehabilitation Information Deficits : Information Deficits Development of national registry Development of institutional data basis Development of: data management facilities data managers research nurses. Development of multi center studies. Prospective Randomized Double blind Integration in Society : Integration in Society Education/rehabilitation Psychosocial adaptation Job/career opportunities Late effects committees in collaboration with medical oncology

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