Challenges in Paediatric Oncology in Recent Days

Description

Over the last three decades, advances in protocol-driven clinical trials and supportive care for children and adolescents with cancer have lowered mortality rates by more than half. Overall, the 5-year survival rate for children with cancer has grown to almost 80%. The discovery of genetic lesions that drive malignant transformation and cancer progression as well as a better understanding of the basis of drug resistance will undoubtedly catalyse further advances in risk-directed treatments and the development of targeted therapies and boosting cure rates even further.

Novel formulations of established chemotherapeutic medicines, monoclonal antibodies against cancer-related antigens and molecular therapies that target genetic abnormalities and their associated signalling pathways are all examples of emerging new treatments. Recent discoveries linking pharmacogenomic variations to drug exposure, side effects and efficacy should hasten efforts to develop personalised therapy for individual patients. Finally, palliative care should be considered an integral aspect of cancer treatment to help patients and their families avoid and reduce pain while also improving their quality of life.

One of the development goals is to reduce child mortality; as Low and Middle-Income Countries (LMICs) work toward this objective and efforts focused at lowering the burden of noncommunicable diseases, such as paediatric cancer, must be established. The burden of childhood cancer is shifting to LMICs; worldwide paediatric cancer care and control measures are urgently needed. It has been demonstrated that international partnerships that provide stepwise approaches that increase capacity while incorporating epidemiology and health services research and implementing intensity-graduated treatments are beneficial.

Cancer is a disease characterised by a cascade of genetic and epigenetic changes influenced by inherited factors as well as the somatic environment. Individual cells develop a phenotype that gives them an advantage over surrounding normal cells as a result of these alterations. Many discoveries in cancer cell biology have been discovered through the study of juvenile cancers which has increased our understanding of the processes that occur during malignant transformation.

Obesity epidemiology, chemotherapy pharmacology, and outcomes in obese adults with cancer, increased mortality in obese paediatric patients with Acute Myeloid Leukaemia (AML) and problems in obese survivors were all discussed at a recent Children's Oncology Group meeting. The main points are outlined below. The Body Mass Index (BMI) is a commonly used weight measurement based on height and age. Obesity prevalence is raising in all paediatric age groups in the United States with black and Hispanic teenagers experiencing the highest growth. Pharmacologic studies are few and far between: medication half-lives, volume of distribution and clearance in obese people differ. Obese adults with solid tumours often experience less damage suggesting underdosing.

Obese persons are more likely to encounter toxicity after receiving a bone marrow transplant. Obese patients with paediatric acute myeloblastic leukaemia have higher treatment-related mortality (TRM), similar toxicity and relapse rates and shorter survival than non-obese patients. Obesity is common among female survivors of childhood leukaemia who had cranial irradiation. Childhood cancer treatment side effects may predispose to a sedentary lifestyle.

Children with cancer have many psychological challenges and require a particular strategy to conceptualise and operationalize the issues they experience. Increased levels of despair, anxiety and mortality fears are all examples of psychosocial impacts. Patients and relatives can better understand and operationalize the psychosocial burden of cancer by dividing psychosocial functioning into domains. Patients can often learn to prioritise the need for psychological and behavioural therapies guiding the therapy focus in this direction.

This discussion will be limited to the physical, emotional, cognitive and familial realms for the sake of simplicity. These domains do not exist in isolation, but rather overlap. The image of the Olympic emblem is one example that helps patients understand the concept of domains. An overlapping circle represents each domain. There are various subgroups of psychosocial influence within each category. The severity and genesis of the disease, the level of psychosocial suffering and the existential meaning of the sickness and therapy to the patient and family are examples of such subgroups.