This document discusses childhood cancer in Pakistan. It notes that over 7,000 children are estimated to get cancer in Pakistan each year, with the most common types being leukemia, lymphoma, and bone tumors. Overall survival rates are below 30% in developing countries compared to over 75% in developed nations, due to issues like late-stage presentation, limited expertise and infrastructure, and inability to afford treatment. While the situation has improved in Pakistan with more pediatric oncology units and trained specialists, major challenges remain including a lack of awareness, high patient volumes, limited resources and support services, and financial barriers to care. Increasing capacity, access, and support are needed to improve outcomes for children with cancer in Pakistan.

1. M.SHAMVIL ASHRAF

2. How many children with cancer
you have seen in last three
months?

3.  Global Burden of Cancer
 Burden in Pakistan
 Common cancer in children
 What is survival data in developed countries
 What has made the difference
 What is the data in developing countries
 What are the problems in developing
countries
 Pediatric oncology in Pakistan in 1990`S
 Current Status
 What is solution

4. • Each year more than
160,000 children are
diagnosed with cancer
in world.
• More than 80% are in
resource-constrained
countries. 0
50000
100000
150000
200000
0-14 years 0-19 years
More Developed Countries Less Developed Countries

5. • 100-120 new cases per million children get
cancer every year
• Pakistan population 180 million
• Under 15 39%
• Karachi Cancer Registry 94/million
• Based on this data it is estimated that about
7,000 children get cancer every year in
Pakistan.

6. 31%
10%
21%
9%
3%
7%
2%
4%
7%
3% 0%3%Leukemia
Lymphoma
CNS
Sympathetic NS
Retinoblastoma
Renal
Hepatic
Bone
Soft Tissue
Germ Cell
Carcinomas
Other

7. Disease Percentage
Leukemia 35
Lymphoma 20
Bone Tumor 08
Soft Tissue Sarcoma 07
Brain Tumor 07
Retinoblastoma 06
Neuroblastoma 04
Wilms Tumor 04
Germ Cell Tumor 03
Others 06

8. USA-WUSA-W BrazilBrazil UgandaUganda CCHCCH
LeukemiasLeukemias 3131 2828 66 3535
LymphomasLymphomas 1010 2121 2929 2020
CNSCNS 2121 1313 11 77
SympatheticSympathetic 99 22 11 55
RetinoblastomaRetinoblastoma 33 88 66 66
RenalRenal 77 99 44 55
HepaticHepatic 22 00 11 22
BoneBone 44 66 33 77
Soft TissueSoft Tissue 77 44 4141 77

9. What do you think is the overall
survival of childhood cancer in
 Developed countries
 Developing countries

10. 77.5
0
20
40
60
80
100
1975 1980 1985 1990 1994
Age 0-14 Age 0-19
Percent

12.  Use of combination chemotherapy
 Integration of multidisciplinary approaches
 Employment of clinical trial methodology
 Centralization of treatment
 Better understanding of molecular basis of
disease
 Improvement in supportive care

13.  Cure rate in developing countries currently
<30%
 Currently, only 20% of all children with cancer
receive treatment sufficient to give them a
chance for cure

14. 0
20000
40000
60000
80000
100000
120000
140000
M o re
D e v e lo pe d
Le s s
D e v e lo pe d
D e a ths
C a s e s
NB. Data extrapolated from existing registries –
the true situation is probably significantly worse

15.  More children are now diagnosed with cancer
 Better diagnostic facilities
 Higher incidence
 Mortality and morbidity due to communicable
diseases are on decrease; cancer becoming
relatively more important
 Availability of treatment in children cancer
units
 Better Cancer awareness
 Treatment is right of every child
 Cancer is curable in Children

16.  Childhood cancer were treated by general
surgeons and pediatricians
 Some had access to radiotherapy centers of
Pakistan Atomic Energy Commission
 Only 3 paediatric oncology units and qualified
Peds oncologists (Lahore and Islamabad)
 No organized facility in Karachi

17. NAME OF INSTITUTION CITY Annual New Cases
(aprox)
National Institute of Child Health Karachi 225
Children Cancer Hospital Karachi 220
Aga Khan University Hospital Karachi 50
Liaquat National Hospital Karachi 40
Sindh Institue of Urology & Transplant Karachi 25
Shaukat Khanum Cancer Hospital Lahore 300
Children Hospital Lahore 250
Mayo Hospital Lahore 100
Services Hospital Lahore 50
INMOL Lahore 80
Allama Iqbal Medical College Hospital Lahore 50
Children Hospital Multan 50
Pakistan Institute of Medical Sciences Islamabad 120
Combined Military Hospital Rawalpindi 100
Shifa International Islamabad 10

18.  50% children do not get proper diagnosis and
treatment
 50% of those being treated do not get active
protocol because of advanced stage disease
and lost to follow up
 50% of those getting active protocol are
cured
 Overall 20-25% children are cured of
cancer in Pakistan

19.  Too many patients
 Limited expertise
 Advanced stage Disease
 Co-morbids
 Lack of awareness
 Very few POC
 Lack of infrastructure
 Inability to afford treatment
 Social issues ; distance from treatment
center

20.  Fully trained Pediatric
Oncologists are very
few
 Even Pediatricians
and other specialist
treating childhood
cancer are very few

21. Courtesy, Dr Ashraf

22.  Delay by the parents in seeking medical
advise
 Delay by the doctor in suspecting cancer
 Delay by the parents in getting test done
 Delay in reaching oncologist
 Delay in starting treatment
LACK OF AWARENESS AMONG
DOCTORS AND GENERAL PUBLIC

24.  Many centers lack
 Infection control team
 Good oncology nursing
 Psychosocial support
 Palliative care team
 Adequate blood transfusion
services

25.  At some centers more than 30% children are
either lost to follow up before starting
treatment or during treatment
 The major reasons are
 Distance from treatment center
 Financial issues
 Lack of awareness
 Alternative medicine

26.  Infection is one of the leading cause of death
among children suffering from cancer
 It varies from 10 -30% in different centers
 Just by reducing infective deaths we can
improve overall survivals

27.  Almost 100% in government hospitals andAlmost 100% in government hospitals and
about 80% in private sector can not affordabout 80% in private sector can not afford
cancer treatment.cancer treatment.
 Even if treatment is provided free for many
it is difficult to meet expenses of stay away
from home.

28.  13 Pediatric Oncology Units
 More Pediatric Oncologists
 Fellowship program in three units
 Hospital based registry in 5 units
 Karachi Children Cancer Registry just begun
 About 40% children are getting standard
treatment
 Outreach training program of Children Cancer
Hospital for nurses and doctors approved in My
Child Matters Project for UICC

29.  Moving towards common protocols
 Pakistan Society of Pediatric Oncology in
process of registration
 Better childhood cancer awareness
 More financial support (mainly Philanthropy)
less abandonment

30. Limited
Resources
Many Patients
With Advanced
Disease and
Many Potential
Patients
LOW
CAPACITY
POOR
ACCESS
High
Mortality
Rate
Unmet
need for
terminal
care

31. Less Limited
Resources
Fewer Patients
with More Limited
Disease and
Fewer Potential
Patients
Prevention
Education
Screening
GREATER
CAPACITY
IMPROVED
ACCESS
Lower
Mortality
Rate
Less need
and greater
capacity for
terminal
care