Pediatric cancers in Bihar: A retrospective tertiary cancer center study

Addressing the Alarming Rise in Pediatric Cancer Prevalence in India: A Call to Action

Background

Childhood cancer has become a pressing global concern, impacting over 200,000 children annually, and is projected to escalate to 21 million diagnoses by 2030. This article discusses the growing incidence of pediatric cancer in India, describes the unique obstacles it faces, and encompasses a strategy for solving this pressing problem.

Methods

We reviewed published scientific literature and available information on cancer control and prevention programs in India.

Results

According to the National Cancer Registry Programme, in India, childhood cancers (0-14 years) constitute 4.0% of all cancer cases. The surge in childhood cancer cases in India mirrors a global trend, emphasizing the necessity for a comprehensive understanding of contributing factors. Pediatric oncology in India faces challenges arising from limited rural healthcare access, resulting in delayed diagnosis and treatment. Socioeconomic factors hinder specialized pediatric cancer care, accentuating the need to bridge these gaps through targeted interventions, improved infrastructure, and policies. Additionally, there are limited population-level epidemiologic studies on environmental, lifestyle, and genetic risk factors and childhood cancers. Research on genetic and environmental determinants is crucial for developing effective treatments. Addressing this requires public education, enhanced medical and research training, community-based cancer screening, and integrated medical care initiatives. Advocacy and awareness campaigns play a vital role in tackling pediatric cancer challenges, supported by grassroots initiatives and collaboration between the government and nongovernmental organizations.

Conclusion

Despite recent efforts by the Ministry of Health, Government of India, childhood cancer lacks a specific policy in India. Urgent collective efforts are needed to address challenges, invest in research, enhance awareness, and advocate for policy changes. It is time for healthcare professionals, policymakers, researchers, and the public to collaborate and ensure no child in India is left behind in the fight against pediatric cancer, paving the way for a healthier future for the nation's youngest members.

Controversies and Challenges in the Management of Osteosarcoma-an Indian Perspective

Osteosarcoma (OGS) is the most common primary bone tumor in children and adolescents which requires a multidisciplinary approach to management. Although chemotherapy and surgery can cure more than half of localized OGS cases, the unique challenges faced by resource-limited countries like India make this outcome difficult to achieve. Various questions in the management of OGS including role of high-dose methotrexate (HDMTX) in neoadjuvant setting, triplet vs doublet chemotherapy, intensification of chemotherapy based on response in setting of doublet, and indigenous prosthesis in setting of limb salvage need to be defined. Similarly, in the metastatic and recurrent setting, questions regarding intent of treatment, indications of chemotherapy, timing of surgery, and role of targeted therapies need clarification. Lack of randomized trials from India makes definite conclusions difficult, but an attempt can be made to define the best approach in the Indian scenario from available evidence. Hence, a critical review of literature from India and the West was done to define possible management approaches and highlight the lacuna for future research.

Clinico-Hematological Profile of Acute Leukemia Cases in Bihar: A Multiparameter Study in a Tertiary-Care Hospital

Objective The actual incidence and demographic profile of hematological malignancies are unknown in Bihar because of lack of population-based cancer registry (PBCR) data and specialized tertiary cancer center facilities. The objective of this study was to estimate the prevalence, clinico-hematological profile and subtyping of acute leukemia cases by retrospective medical records.

Materials and Methods A retrospective study was conducted in the Department of Hematology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, over 2 years from July 2019 to June 2021. A total of 176 cases with relevant clinical features and hematological findings were involved in the study. Medical records were studied and data were retrieved.

Statistical Analysis Data were recorded and analyzed using SPSS version 25.

Results A total of 176 cases with relevant clinical features and hematological findings were involved in the study. Acute myeloid leukemia (AML) was most prevalent (52.8%), followed by acute lymphoblastic leukemia (ALL) (34.1%) and unclassified acute leukemia cases (13.1%). Flow cytometry correlation was available in 150 cases. The ratio of males (62.5%) to females (37.5%) is 1.6:1. There was statistically significant difference in physical examination findings between AML and ALL patients. Splenomegaly, lymphadenopathy, and sternal tenderness were more often seen in ALL than in AML patients (p < 0.05). Pallor was more significantly associated with AML than with ALL patients (p < 0.05). Anemia and leucocytosis were found to be significantly associated with acute leukemia patients (p < 0.000).

Conclusion AML M2 was the most common subtype of AML, and B-ALL was the most common subtype of ALL cases.