November, 2019 - The Suno India Show

Why does India have an abysmal record in curing childhood cancers?

Did you know that cancer in children constitutes 5.5% of total cancer cases in India according to the Indian Council for Medical Research? A study published in 2016 stated that this percentage has more than doubled from the previous decade. However, only a small percentage of children suffering from cancer receive or are able to complete the treatment. While cure rates for common childhood cancers are over 80% in the developed world, in India, they hover around 30%.

On the occasion of National Cancer Awareness Day, we bring this special episode featuring a conversation with Dr. Sudha Sinha, Medical Oncologist, American Oncology Institute, Hyderabad.

Click here to listen to podcast.

June, 2012 - Journal of Clinical Oncology

Recent JCO article reports 90% cure rate for children with acute lymphoblastic leukemia, the most common cancer in children.

Improved Survival for Children and Adolescents With Acute Lymphoblastic Leukemia Between 1990 and 2005: A Report From the Children's Oncology Group

Purpose To examine population-based improvements in survival and the impact of clinical covariates on outcome among children and adolescents with acute lymphoblastic leukemia (ALL) enrolled onto Children's Oncology Group (COG) clinical trials between 1990 and 2005.

Patients and Methods In total, 21,626 persons age 0 to 22 years were enrolled onto COG ALL clinical trials from 1990 to 2005, representing 55.8% of ALL cases estimated to occur among US persons younger than age 20 years during this period. This period was divided into three eras (1990-1994, 1995-1999, and 2000-2005) that included similar patient numbers to examine changes in 5- and 10-year survival over time and the relationship of those changes in survival to clinical covariates, with additional analyses of cause of death.

Results Five-year survival rates increased from 83.7% in 1990-1994 to 90.4% in 2000-2005 (P < .001). Survival improved significantly in all subgroups (except for infants age ≤ 1 year), including males and females; those age 1 to 9 years, 10+ years, or 15+ years; in whites, blacks, and other races; in Hispanics, non-Hispanics, and patients of unknown ethnicity; in those with B-cell or T-cell immunophenotype; and in those with National Cancer Institute (NCI) standard- or high-risk clinical features. Survival rates for infants changed little, but death following relapse/disease progression decreased and death related to toxicity increased.

Conclusion This study documents ongoing survival improvements for children and adolescents with ALL. Thirty-six percent of deaths occurred among children with NCI standard-risk features emphasizing that efforts to further improve survival must be directed at both high-risk subsets and at those children predicted to have an excellent chance for cure.

August, 2011 - The Hindu, Hyderabad

Taking care of children afflicted with leukaemia

Husain, a boy hardly of eight years, was asked to be taken away from the Indo-American Cancer Hospital when he began to have seizures. For, his parents could not afford the expensive treatment for his Leukaemia.

The boy was taken to Gandhi Hospital from where he was referred to the MNJ Institute of Oncology and Regional Cancer Centre. Here, the treatment is absolutely free and efforts are on to put him on the track of recovery.

Lakshman Reddy, a 14-year-old tribal boy from Khammam, was brought to NIMS by the ITDA officials, where he was diagnosed with Leukaemia and referred to MNJ Institute. An orphan, he is now recovering in the Paediatric Oncology Ward, and is known for his erratic behaviour. He smokes, throws tantrums and occasionally refuses to take food and medicines.

Even after the boy has reached the stage of maintenance therapy, he is made to stay as the hospital authorities are unsure if he would return for medicines. Three years ago, such individual concern was absent in the hospital which on a regular basis receives far more patients than it can effectively handle. Right from diagnostics and availability of blood, every dispensation was a problem.

Treatment abandonment rate was very high as parents would not bring the children back either unable to bear the train fare, or due to lack of awareness. Due to this, many children with good scope of recovery too were left to die. Now, thanks to ‘IMPACT' (Improving Access to Care and Treatment), an organisation founded by a group of individuals, no child is allowed to meekly succumb to the dreadful malady. The Treatment Abandonment Rate is brought down from 50 per cent to 10 per cent and the cure rate is expected at 45 per cent as against the earlier five.

Under the initiative, an exclusive 14-bedded paediatric oncology ward was set up in 2008, and extended to 40 beds with support from NATCO.

An Immunohistochemistry Lab was set up with Rs.1 lakh apart from generous donations in kind. IMPACT also supports salaries of a team of six trained nurses, three nursing aids and two counsellors for the ward. Counsellors facilitate everything for the patients, be it doctor's appointment, blood or medicines or recommendation for financial support. The programme involves fundraising to provide medication, blood and transport for poor patients. Deserving special mention is the Paediatric Palliative Care Programme, under which the counsellors keep track of terminally ill children in their homes, and constantly monitor their health through telephone counselling, suggestions or mere verbal support. While NATCO appointed the counsellors, IMPACT pays for transportation and telephone charges.

"IMPACT is born of the need to treat childhood cancer cases separately. The disease behaves differently in a child than it does in an adult. Recovery prospects are more among children. They need specialised intensive treatment which is most often ignored," says Sudha Sinha, Medical Oncologist at the hospital and one among the key persons in the programme.

February, 2009 - The Times of India, Hyderabad

New lease of life for cancer-hit kids

HYDERABAD: Twelve-year-old Naveen from Karimnagar has blood cancer. His father, a vegetable vendor, could not afford the expensive tablets for his son. After they approached the MNJ Cancer Research Institute for treatment, Naveen not only responded well but also started going to school again.

Hundreds of terminally-ill children suffering from cancer are being given a new lease of life at the MNJ Institute of Oncology and Regional Cancer Centre with its recently launched `Childhood Cancer Programme' with an exclusive cancer care unit for children.

Besides, the institute now has collaborated with St Jude Children's Research Hospital, Memphis, US, recognised for its work in saving children with cancer. "Twice a month, we present our data. In between, if difficult cases come up, we write to them and they guide us on how to deal with them. In a year, we are trying to bring the success rate to at least 60 per cent at least," MNJ Hospital, paediatric oncology, head, Dr Sudha Sinha said.

According to Dr Sinha, the situation, till recently was pretty gloomy. The survival rate at MNJ two years ago was less than 10 per cent. A proper facility devoted to children, specialists in paediatrics oncology, round-the-clock blood bank, trained nurses for performing chemotherapy were lacking. The treatment and the regimen have been modified instead of replicated as in the West.

As part of the programme, a special ward with 14 beds, dedicated social workers, free food for patients and their attendants, counselling for parents, transportation costs are being met. Nearly 40 patients are occupying the 14 beds, exposing the woefully short facilities at the government hospital.

Also, the department has come up with a patient tracking software, wherein as per the treatment schedule, the hospital staff would call them up and remind them of their appointment with the expert. As patients from far off villages get treatment at MNJ, the new software is proving to be a boon to them. The treatment spans anywhere between two to six years and it was becoming impossible for them to visit the hospital often. There was treatment abandonment in 50 per cent cases. "Because of this programme, almost everybody is reporting back for follow-up treatment," Dr Sinha said.

The hospital, which gets around 500 paediatric cancer patients every year, was treating children along with adults. "We were forced to treat and keep children along with adults. With this unit, children are being given specialised care," MNJ Institute of Oncology & Regional Cancer Centre director Dr T Mandapal told TOI.

MNJ has around 40 child cancer in-patients on any given day, while another 20 get treated as out-patients. "If we include MNJ and Niloufer, 200 deaths occur due to cancer in the city per year," Dr Sinha said.

The programme is being funded by philanthropists and NGOs including IMPACT in collaboration with Round Table 8, Hyderabad Ladies Circle 43 and a software company. The hospital is also looking for sponsors for each month. "As of now, we have five sponsors ready. After this, we have to scout," Dr Sinha said.

October, 2008 -

Creating an IMPACT Dr. Sudha Sinha

Dr. Sudha Sinha would pass off as the ideal daughter of parents of the eighties and nineties vis a vis opting for BiPC in the intermediate level, making it to medical college, marrying a software engineer and moving to the US of A to make pots of Green Bucks. The story thus far went off well but post residency and fellowship in Oncology and Hematology the couple ‘consciously' decided to pack bag and baggage to return. Today she is Asst. Professor Medical Oncology, Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Center, Saifabad. The passage to and on this seat was not an easy one and could be likened to a car rally drive with issues of going the wrong way, shortages, stoppages and breakdowns.

In retrospective?

"We went to San Jose, we did all the correct places went to New Jersey and then Boston. I did my residency in New Jersey (Oncology) and my fellowship in Boston (Hematology) each of three years. Shravan and I always wanted to come back as staying there was not an option. We took the next flight out the day I finished my Fellowship. Did a small stint at Apollo Hospital but that was not what I was brought up on, coming from a family of people working with the government or for the government. Kept tabs on the advertisements being released from MNJ and grabbed the chance when it came by."

Life at work?

"It has been very different in many ways from what I thought it would be. I was this idealistic person thinking I will have to do separate surveys on cancer, working with poor people and helping them out. The difference is, yes there are poor people and since I have worked in government hospitals previously I know the system prevalent there but the suffering a cancer patient goes through is totally dissimilar and is on a different plane. It hit me hard, a rude shock to say the least the misery gone through by the patient is indescribable and to add to my woes, the two other doctors employed here left for greener pastures. The picture changed dramatically as the only oncologist armed with an American degree was left to deal with a sea of approximately two hundred patients a day. You can imagine what I went through those days".

About Cancer?

There are many cancers that can be cured completely and we were not dealing with them. The reasons were varied, some patient specific and trivial, for instance not having the money to travel to the hospital or nobody to accompany them here, not being told that the disease can be totally cured in four or five sittings. Another thing that struck me was the number of children coming here with cancers and the mother in me decided to move in that direction.

After much deliberation a ward for Pediatric Oncology was started in October 2008, with fourteen beds. Within a month the numbers rose to fifty and from then on we have been averaging forty to fifty children per month. Treating children is a different ball game and it comes with a lot of uncalled for trouble from parents or the children themselves. To deal with such problems a group of my friends formed ‘IMPACT'. They as an NGO would come to the aid of those patients failing to come to terms with the disease both materially and mentally by giving financial help and counseling them about the ways to cope with the predicament. In most cases the difficulty is compounded when the parents of the child undergoing treatment have to come leaving behind family and wages to tend to this one child. There was this case I recall where the father of the child was crying inconsolably and the reason was his wife and other children were also sick. When the counselor spoke to this parent it was discovered that the only person willing and able to come and watch over the child was his grandmother but she suffered from Diabetes. A prompt decision was taken by us and the outcome was that the grandmother gets her ailment treated while keeping watch over the child. The point was to look at it from the patient's point of view or in short from the other end of the yardstick. We have succeeded to a very great extent and most of these three years, since I've taken charge, have been spent in trying to put these vehicles in place so that there is no hindrance to our work and since it is the capital of the state we would like to make it a role model for other centers to follow".

While speaking to Dr. Sudha Sinha one thought kept playing in the mind; why this lady is so and upon being asked she said something very natural, "By nature and nurture". She has a long list of people from her family in public service or held public office. Her paternal grandfather Mr. Bijoy Kumar Sinha was a freedom fighter, her maternal grand father Mr. M. Anandam was a Rajya Sabha MP, her mother Ms. Shantha Sinha is a Magsasay Award winner. Her husband Mr. Shravan Karpuram is the Vice- President Tata Business Service Solutions, Hyderabad and is involved with Project 511 that builds or renovates Government Schools in Andhra Pradesh. An impeccable lineage!!