World Cancer Leaders’ Summit 2015
Future training possibilities in paediatric oncology
Dr Cristina Stefan - Vice President, South African Medical Research Council
Matt Seymour was talking earlier about rare cancers, that actually is where paediatric cancers fall in, thankfully, and the big issue there is training. So how do we go about training general practitioners, nurse specialists, adult oncologists, paediatricians who don’t know anything about oncology, how do we get the message over about how important it is to find paediatric cancer patients early and put them through specialist centres etc.?
Training is definitely extremely important but before elaborating on the training I need to make perhaps a remark about rare cancers because what is the definition of a rare cancer? Of course according to the definition paediatric cancer is rare because the incidence which is described in the literature is anything between 1% of the total cancers, 2% of the total cancers, up to 10% of the total cancers. The reality is that we don’t actually know because most of the countries in Africa do not have a registry so we are basically guessing or we have estimation based on the GLOBOCAN. But this being said, of course it is a rare cancer unless the family that has a child is affected by this disease because then, despite the fact that it is rare, that family really has a fantastic burden and a lot of suffering.
So, this being said, training in paediatric oncology is extremely important. It’s important because most of the people involved in diagnosing cancer are actually the nurses or actually the general practitioners. If we look again on the African continent where I do most of my work we do have actually a quite limited number of paediatric oncologists. We’ve done recently a survey including most of the countries on the African continent and some of the regions, basically, do not have any specialists. So they are either the paediatricians who are treating those children or the general practitioners or sometimes the adult oncologists and they do lack the required experience. Because despite the fact that paediatric oncology deals with cancer, the training between adult oncology and paediatric oncology is completely different.
So, this being said, at the moment there is on the African continent, where I do most of my work, a school, it’s the Franco-African School, which has as its aims to train as many doctors in paediatric oncology and not only specialists but nurses as well. We are planning to develop a curriculum on the sub-Saharan Africa as well.
How are you going to disseminate that? Not everybody can afford to come to school, meeting face to face, although it would be ideal if they could.
At the moment we are trying to develop a system by which we could have twinning programmes between different centres in Africa which obviously it would be the easiest to work and then spend a certain amount of time in those recognised and specialised centres. Then, of course, having case scenarios and case discussions and, based on that, at the end have a diploma which will give them, let’s say, more knowledge in diagnosing and treating the children with cancer.
ecancer is dedicated to developing educational modules, would you see any role for that in terms of networking?
Oh definitely, definitely. I mean that will be the way to go because, as we all know, it will be extremely difficult to take those doctors and get them for two years or three years in a specialised centre. So obviously the e-learning and using such a technology will be for the advantage of all.
How do you get the message over that children with cancer should be in an expert centre? Or is that just logistically impossible?
That’s quite difficult. Obviously this is the ideal solution where we could really centralise the knowledge and also the equipment which is not always available and in most of the situations could be quite expensive. But sometimes it’s quite difficult because, as you know, patients need to travel for very long distances in order to reach that centre. The mother who comes with a child to the specialised centre will leave behind a family with many other siblings. So despite the fact that this is the ideal scenario perhaps it will be quite difficult to implement. So in this situation it will be perhaps acceptable to have the child diagnosed in a specialised centre and then to try to let the child go to the nearest clinic where basic investigations follow up an administration of chemo, let’s say oral chemo could be given. Despite that one needs to be really careful about the side effects and really a very close monitoring of those children.
Psychological care is also important and particularly for the whole family. How on earth do you deliver that in Africa?
Interestingly enough about this topic, we are having tomorrow a workshop on the psychosocial problems – dealing with the trauma of the families. And actually not only the families but of the entire society because a child with cancer does not affect only the child as such but an entire environment – the family, the working place where the parents do work and the whole society. So we have special programmes obviously still at the very early and the very beginning trying to address this problem, such as palliation, for example, which is quite an important aspect and it is quite difficult in some situations to deal with these psychosocial problems.
ecancer has published twenty modules on palliative care in Africa, is that helpful or not? It doesn’t deal specifically with children but of course children make a large part of the population.
Definitely it is an essential component, however there are still many centres which do lack essential medicines such as morphine. So one really needs to keep going on trying to increase awareness and trying to really let the government know and do more because it’s actually not always about the cost because the cost of the morphine or the cost of the palliation is not always as high as it is mentioned. So from this point of view advocacy, increasing awareness, education, will play definitely an important role.