Pediatric Hematology Oncology
Children & Adolescent Cancer Care Centre
Pediatric Cancer treatment Services for Children with Cancer and Blood Diseases. This specialized service comprises of Pediatric Hematology Oncology Outpatient Clinics and Day Care Unit, Inpatient Wards and Bone Marrow Transplantation Unit.
Childhood Cancer is a catastrophic disease, if untreated it is potentially fatal. It afflicts all communities. Based on recent data, it is estimated that 10 - 12 children per 1, 00,000 population will develop cancer every year. Hence in India, with a population of over a billion, it is roughly estimated that about 50,000 children develop cancer each year and many either go undiagnosed or without adequate treatment. Of these, a mere 15 - 20% i.e. 10,000 children are able to reach a cancer unit. And among the latter 40 to 50% i.e. 5,000 children drop out of treatment. Most children therefore die without proper therapy. This is the reason that lay public, as well as many in the medical fraternity believe that cancer is potentially incurable in India.
It is worthwhile knowing that of the 8.5 lakh cases of cancer that occur annually in India, only 3 - 5 % occur in children. These cancers are very fast growing but also very sensitive to proper treatment. Although treatment is complex and often long, cure is a very realistic and practically achievable goal.
Although the actual number of children who develop cancer is small, the cure rate is high and total number of productive
life years saved by curing these children is significantly high and therefore the effort in treating appropriately is all the more worthwhile and fulfilling.
We are aware that our journey is fraught with difficulties, but we are encouraged by these words of wisdom:
Even though the big canvas leak,
Let’s concentrate on the little strokes,
That would make the difference
The Department of Pediatric Cancer treatment and Oncology at RGCI & RC, is unique in India, as it offers comprehensive Oncology Care to all children up to the age of 18 years. It is a place, where doctors send some of their most challenging and sick patients. The Department has a dedicated team of experts in the field of Pediatric Hematology / Oncology. The team constituted by experienced Pediatric Oncologists, Hematologist, Pediatric Oncosurgeon, Radiation Oncologist, Pediatric Oncology Residents and Nurses, Child Psychologist and Playroom Teachers' who works hard to ensure, that best care is delivered to every child.
Children with all types of Hematological and Solid Organ Malignancy receive specialized Oncology services here. The various type of Cancers treated in the Department includes Leukemia (ALL, AML, CML), Lymphomas (non-hodgkin’s and hodgkin’s), as well as all Pediatric solid Tumors like Neuroblastoma, Wilms Tumor, Bone and Soft Tissue Sarcoma, Brain Tumor, Hepatoblastoma, Testicular and Ovarian Tumors etc. Patients with different Hematologic problems like severe Aplastic Anemia, MDS, Hemolytic Anemias, Chronic ITP, etc are also managed.
Recognizing the special needs of children with cancer, the hospital has designated areas for Pediatric patients. In the outpatient area there is a special clinic for children with a separate waiting area and Pediatric Daycare facility (for outpatient short term Chemotherapy and Blood Transfusions) manned by Pediatric Nurses. The in-patient area has two Pediatric wards as well as a Playroom for children. The Bone Marrow Transplant unit is well equipped to handle Pediatric Autologous and Allogenic BMT’s and several BM and PBSC transplants have been successfully achieved by the Institute. There is a dedicated team of experts in the field of Pediatric Oncology which includes Pediatric Oncologist, Pediatric Onco Surgeon, Radiation Oncologist, Pediatric Onco Nurses and the team enjoys the expertise of Supportive Departments.
The service treat all children and adolescents up to the age to 18 yrs, with Leukemias, Lymphomas, Brain Tumors, Bone and Soft Tissue Sarcomas, all other Pediatric Solid Tumors in addition to a variety of Hematological Conditions like Immune Thrombocytopenia, Thalasemia, Inborn Errors of Metabolism and Bone Marrow Failure. Patients have the benefits of comprehensive Multispecialty Care including Chemotherapy, Pediatric Surgical Oncology, Radiotherapy and Supportive Services (Pediatric Oncology Treatment, Nurse Co-ordinator, Dietician, Counselor, Teacher and Play Therapist). All these provided by a highly specialized, trained, experienced and dedicated team of experts.
Quality patient care remains at the core of our mission, and it is the hallmark of our Department. Families of the sickest children in our society continue to seek care here as they received the best care available as well as family support that makes all the difference.
These are held on all working days, six days a week, Monday to Saturday.
Specialized Pediatrician and support staff examine, diagnose and treat several patients a year on an Ambulatory basis. These are primary settings for the treatment of children suffering from Cancer and Chronic Blood disorders, designed to provide coordinated Medical Care & Psychosocial Support for the children and their families. The staff consists of physicians and nurses, as well as a team of specialists, in the fields of Oncology, Social Work, Psychology, Art and Party-Therapy. Most of the Therapy and Procedures are provided on an Ambulatory Basis.
Day Care Unit for Children
The day care unit comprises a special area where children receive short treatments without need for Hospitalization. It is the policy of the Pediatric Oncology Department to carry out maximum possible treatment through the Outpatient Department, rather than through In-patient admission. This allows the child to spend maximum time at home with his loved ones. For this purpose, the Institute has a Day Care Ward which is open from 8 am to 7:30 pm, on all working days. This facility can be utilized for children requiring short treatment in the form of Chemotherapy, Line Care, Blood Product Support of intravenous fluids and Antibiotics. All outpatient procedures are also carried out here. These include Bone Marrow Aspiration, Biopsies and Intrathecal Injections which are performed under mild Sedation. Child requiring deeper IV Sedation has their procedures performed in the minor operation theatre under anesthesia backup. The area is well equipped with toys and games various ages.
There are about 15 beds dedicated exclusively for children in the inpatient facility. The children are cared by specially trained nurses in Pediatric Oncology. There are one or two senior nurses who supervise and assist all treatment for the children.
In order to make the child’s stay and treatment in the hospital as pleasant as possible, the Pediatric Oncology Department has established a Playroom on the second floor. It is equipped with a TV, VCR, Videogames, many Books and Various Toys. Children are free to use the playroom during their visits to the hospital. They may even receive short chemotherapy here, as there is a nurse stationed here.
It is quite clear that the families of children diagnosed with cancer need psychological support to encourage them, keep their morale and help them through the treatment. For this purpose there is an in-house clinical physiologist for counseling and a meditation room in the basement.
Pediatric Onco Surgery
Surgery in children with cancer has a major role in same tumors like Wilms Tumor, Neuroblastoma, Bone Tumor, Soft Tissue Sarcoma, Gonadal Malignancies, Brain Tumor etc and it has a supportive role in Leukemias and Lymphomas where mainstay of treatment is Chemotherapy. All surgical procedures are performed by surgeons who are specifically trained in the field of Pediatric Oncosurgery. Pediatric Cancers are potentially curable and in the modern era. The focus is to formulate treatment plans with minimum complication and suffering. Pediatric Oncosurgery plays a major role in decreasing the morbidities of cancer treatment
Initially the treatment of long bone tumors was amputation of the limb but now most of the tumors can be resected without sacrificing limb especially if tumor is detected in early stage. We want to cure, but not by performing mutilating surgery. This is made possible by multimodality approach and working in close association with Pediatric Oncologist, Orthopedic Surgeons and Radiation Therapist.
While treating a pediatric cancer patient a lot of stress is laid down on maintaining the reproductive abilities of these patients. Pelvic tumor like PNET, Rhabdmyosarcomas which require Radiation Therapy to pelvis, may impair the ovarian functions and minimally invasive surgery can be undertaken, to move the ovaries out of the radiation field and thereby saving the ovaries from radiation.
Most of the pediatric patients are afraid of needle sticks. We deal with this problem by placement of central vascular access devices like PICC line, Hickman Line and Portacath. These devices make the oncology treatment acceptable and to a great extent painless. All the blood sampling can be done through these devices and all the IV medications can be given through these devices.
We work as a team throughout the treatment. Whenever the patient goes to operation theatre, an experienced Anesthesiologist provides Anesthesia to the patient. One of the parents is allowed to come with the patient to Operation Theatre, after wearing OT clothes. This process alleviated the anxiety of the patient to a great extent.