Paediatric Oncology



Childhood cancer is
not a death sentence


Evidence-based treatment protocols are having far-reaching effects on paediatric cancer survival rates. The American Hospital Dubai’s Dr Nidal Mahgoub stresses the importance of specialist paediatric oncology centres and the need for more data specific to the region. Callan Emery reports.

 

As we sit down in the meeting room of the paediatric oncology unit at the American Hospital Dubai, Dr Nidal Mahgoub removes three boxes of tissues from the centre of the table and says calmly as she puts them on a side table: “We get a lot of tears in here.” I immediately feel a wave of anguish rush over me as the shocking realisation dawns – this is the room where parents are told that their child has cancer.

It comes as a stark wakeup call that we won’t be talking about some minor illness, but about cancer and in particularly children who have cancer, which one imagines in all likelihood will kill them.

Dr Mahgoub is an American Board Certified Consultant Paediatrician Oncologist/ Haematologist at the recently established specialist Paediatric Oncology and Haematology Center at the American Hospital Dubai, one of the city’s leading hospitals.

As if reading my thoughts she comes straight to the point. In her wonderfully reassuring tone she says: “A cancer diagnosis doesn’t necessarily mean that a child will die from it.

“We have come a long way with cancer treatment, robust evidence-based protocols have been developed.” She explains that this has significantly improved treatment, quality of life and cure rates for certain cancers in children.

“The most common paediatric cancer is acute lymphoblastic leukaemia and, if treated correctly, there is an 85- 90% cure rate,” Dr Mahgoub says.

This is phenomenal news.

She emphasises that it is essential that children diagnosed with cancer are treated at a specialist paediatric oncology centre, which gives them access to a multidisciplinary team of doctors including, not only a paediatric oncology specialist, but also chemotherapy certified nurses, radiologists, laboratory technicians, nutritionists and a social worker and psychologist to help the family and relatives cope with the traumatic news that their child has cancer. This is one of the most important aspects for the family and is often overlooked in smaller clinics.

Dr Mahgoub says that the psycho-social dynamics are very important to understand and deal with, particularly with children and teenagers who are diagnosed with cancer.

“Often teenagers will not want their friends to know they have cancer,” she says. “And it is especially important for family and relatives to be aware of these dynamics and know how to work with them.

“This is why it is so important that the family sees a psychologist and social worker at the paediatric oncology specialist centre, as good homecare becomes crucial during treatment.”

The Paediatric Oncology and Haematology Centre at the American Hospital Dubai is the first paediatric oncology centre in Dubai. There are, however, others in the UAE and the wider region. There are specialist paediatric oncology centres at Tawam Hospital in Al Ain and Sheikh Khalifa Medical City (SKMC) in Abu Dhabi, in the UAE. Regionally, there is a paediatric oncology centre at King Faisal Specialist Hospital and Research Center (KFSH) in Riyadh; in Beirut there is the Children’s Cancer Centre Lebanon (CCCL), which is attached to the American University of Beirut Medical Center; and in Amman, Jordan there is an advanced paediatric oncology unit at the King Hussein Cancer Centre (KHCC).

Dr Mahgoub says that although it is, in her experience, too early to say which childhood cancers were most common in the region, in the US and Europe they were the leukaemia’s, particularly acute lymphoblastic leukaemia, followed by the lymphomas and the solid tumours – in this category brain tumours were the most common.

“We are developing a paediatric cancer registry in collaboration with Tawam Hospital,” she points out. This will take at least a year of data collection before specialists can begin to determine any trends in the UAE population.

Jordan has kept a national Cancer Registry (JCR) since 1996, which incorporates child cancer data. The data has been used as an important part of the planning of a national cancer control programme through cancer prevention, education, screening, early detection and treatment. To this end the Ministry of Health has established the Cancer Prevention Directorate to facilitate this initiative.

The compendious nature of the registry is a good example of collaboration between all the health institutions in Jordan – governmental hospitals, royal medical service hospitals, university hospitals, private sector hospitals and all histopathological laboratories.

Data from the JCR show a similar incidence of cancer in children in Jordan as in the US and Europe. In 2004, for example, in children in the 0-4 age group the highest incidence of cancer was for lymphoid leukaemia (10 cases). Cancer of the brain and nervous system had the second highest incidence (5 cases). In the next age group, 5-9 years, brain and nervous system cancer is most prevalent (8 cases). In this age group there were 7 cases of other leukaemia, 3 cases of Hodgkin’s disease and 3 cases of bone cancer. In the 10-14 year age group – other leukemias are most prevalent (8 cases). There were 5 cases of brain and nervous system cancer, 3 of Hogkin’s disease and 3 of Non-Hodgkin lymphoma. Hogkin’s disease becomes most prevalent (11 cases) in the 15-19 age group, as does bone cancer (7 cases).

Treatment

Treatment for childhood cancers can include chemotherapy, radiation, surgery and stem cell transplants. Depending on the age of the patient, the stage and type of cancer, a specific treatment protocol will be used. And with a solid evidence-based foundation, which has been developed over many years, the success of treatment is now much higher than just a few years ago.

The American Hospital Dubai, SKMC, KFSH, the CCCL and KHCC all have JCI accreditation which ensures quality in clinical practice and administration.

KHCC has been awarded two JCI accreditations – a general one and, in 2007, an oncologyspecific accreditation. It is the only centre in the world outside the United States to have this specialist accreditation.

Marmoud M. Sarhan, MD, CPE, Director General and CEO of KHCC, and Professor and Director of the Bone Marrow and Stem Cell Transplantation Programme, tells Middle East Health: “This specialist JCI accreditation looks at protocols and how we deliver care to the patient, what kind of therapy we give and how we use the data from the therapy to improve patient outcomes. It requires more physician involvement than the general JCI, which looks at systems, safety regulations and administration.”

Dr Sarhan says that KHCC uses clinical pathway guidelines (CPG), a system that ensures treatment is consistent.

Each disease has a CPG – breast cancer, brain cancer, infant leukemia, chronic leukemia and so on. The clinical team follows these guidelines which minimises variation and ensures consistent quality.

“After a year or so we look at the results and compare them to the West and then see where we can improve it. Initially these guidelines are taken from the US or Western Europe, but whether they are appropriate or not, you cannot know without looking at the outcome,” Dr Sarhan says. Following this analysis the protocols can be adjusted to better suit the local population and environment. There are many factors that can influence the different outcomes on different population groups using the same treatment protocol, such as genetics and nutrition,” he explains.

Dr Mahgoub says that the Paediatric Oncology and Haematology Center at the American Hospital Dubai follows treatment protocols established by the Children’s Oncology Group (COG ) – <www.childrensoncologygroup.org> COG is the world’s largest cooperative paediatric cancer research organisation, which includes every recognised paediatric cancer programme in North America and comprises a network of more than 5,000 physician, nurse, and other clinical and laboratory investigators whose collaboration in clinical and translational research has turned childhood cancer from a virtually incurable disease to one with an overall cure rate approaching 80%.

Dr Mahgoub issued a call for greater collaboration among paediatric oncology centres across the region in an effort to improve treatment protocols specific to the region. By doing this an even greater number of children will be able to benefit from treatment protocols specific to the region and go on to live healthy lives.

● KHCC has a range of educational resources (available online and in Arabic) for healthcare professionals. Visit: www.khcc.jo/Educational_ resources2.aspx


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ate of upload: 15th July 2009

 

                                  
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