September is National Childhood Cancer Awareness Month – a time to reflect on how we can better understand and address the needs of those affected by childhood cancer.
In South Africa, some 800 to 1 000 childhood cancer sufferers are newly diagnosed annually, but it is believed that this only a third of the actual number of suffers. “The rest are children who undergo surgery without being referred to an oncologist or who die before referral, or are never diagnosed and receive no treatment,” says Prof Alan Davidson, associate professor in the Department of Paediatrics and Child Health at the University of Cape Town and head of Paediatric Haematology-Oncology at the Red Cross Children’s Hospital.
Types of childhood cancers
The National Cancer Institute reports that worldwide the most common childhood cancers among children aged 0–14 years are:
- brain and other central nervous system tumours
- kidney tumours
- malignant bone tumours.
In South Africa, says Prof Davidson, kidney cancer is the third most common childhood cancer.
There is a bright side
Childhood cancers are different to adult cancers, which are often linked to lifestyle factors, such as smoking, environmental factors (pollution, radiation, sunburn), and genetics. Most have no discernible cause. “Some parents struggle with the fact that there is in most cases no easy answer; nothing or no one to blame,” says Prof Davidson.
Second, the prognosis is amazingly good. The overall cure rate for childhood cancer has improved considerably over the past 25 years, even for aggressive types, Prof Davidson says. “Children’s natural resilience is one of the biggest factors countering cancer. They tolerate treatment better than adults and have fewer side effects. Their cancers grow more rapidly than those of adults, but this more rapid growth makes these cancers more sensitive to treatment, and even those in stage four – the most advanced – can today often be cured.”
Early detection can make a world of difference. The sooner a child is diagnosed, the better the outcome for the patient. Prompt treatment is essential for improving the chances of successful outcomes in children with cancer, regardless of the type.
Specialist childhood cancer units linked to major hospitals have a vital role to play. These units offer a multidisciplinary team approach, providing oncology care, treatment centres and support services – from laboratories to social workers and therapists.
United in the fight against childhood cancer
One such operation is a joint venture between Icon Oncology and Cancercare, which led to the establishment of Crayon (Childhood, Radiation, Adolescent, Young Adult, Oncology Network) – a specialist Paediatric, Adolescent and Young Adult Oncology unit based at the Cape Gate Oncology Centre in Cape Town’s northern suburbs. Crayon offers an integrated service with a dedicated multidisciplinary dream team’ devoted to delivering the best possible care and outcomes for its young patients.
Research efforts in South Africa are contributing to a deeper understanding of the genetic and environmental factors that contribute to childhood cancer. This knowledge is paving the way for more personalised and effective treatment strategies, bringing renewed hope to families facing this daunting journey.
Chief among the medical advances, says Prof Davidson, are:
- improvements in the treatment of infections and other side effects, allowing for more intensive treatment;
- implantable ports and lines to take blood samples and deliver chemotherapy;
- surgical advances like minimally invasive surgery and bench surgery, where organs are removed for surgery and then replaced.
- the use of titanium clips to mark surgical beds for radiation treatment
- new forms of radiation therapy to make it safer and more effective
- bone marrow transplantation
- new biological agents.
While progress is undeniable, challenges persist. “Childhood cancer knows no boundaries, affecting kids from all walks of life. The battle against this disease is relentless, and it requires our unwavering commitment to making a difference in the lives of children and their families,” says Dr Johan Riedemann, a clinical radiation and molecular oncologist and the brainchild behind Crayon.
Warning signs of childhood cancer
Parents and caregivers are the first line of defence in children’s health journey, and it is therefore important to have a child checked by a doctor if they have unusual signs or symptoms that persists:
- An unusual lump or swelling.
- Unexplained paleness and loss of energy.
- Easy bruising or bleeding.
- An ongoing pain in one area of the body; especially when present or worse at night.
- Limping without a history of injury/trauma.
- Unexplained fever or illness that does not go away.
- Frequent headaches, often with vomiting.
- Any worsening visual, cognitive and /or hearing abnormalities.
- Unexplained weight loss.
- Loss of appetite,
- Easy fractures;
- A change in balance or gait.
- A change in behaviour or achievement of milestones.
Choc (Childhood Cancer Foundation South Africa) is a non-profit national organisation advocating for the health and wellbeing of children and teenagers diagnosed with cancer. The organisation offers psychosocial, emotional and practical support to those with childhood cancer and their families and runs awareness and education programmes.
Dr Brenda Talbot, a Durban-based child psychologist, and Choc’s psychosocial support services department advise:
- Answer your child’s questions honestly in age-appropriate terms. Never lie; it breaks trust. Giving blood is not painless, so explain that it hurts a bit but will be over fast if they stay still.
- Encourage your child to play out fears with toys or in drawings – acknowledge and name their emotions, and listen actively.
- Treat your child with cancer the same as others in terms of discipline; don’t overcompensate.
- A young child may wonder if they’ve done something bad that made them sick – reassure them. The same is true for siblings, who may feel they’re to blame for the illness.
- The sick child will receive attention and gifts; set aside one-on-one time and small treats for siblings too.
- Encourage your child to participate as much as possible in ordinary activities – achievement builds self-image and socialisation is vital.
- Try to be involved in the illness as a couple so it doesn’t come between you.
- If you have difficulty resolving differences, get professional help.