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International Childhood Cancer Day: IAEA Strengthens Support for Childhood Cancers

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Staff at the Children’s Hospital Teletón de Oncología in Querétaro, Mexico put a young patient at ease before she receives radiotherapy treatment. (Photo: A Silva and J Weilguny/IAEA)

The IAEA joined national governments, UN Agencies and partners in a virtual meeting to mark International Childhood Cancer Day hosted by the World Health Organization (WHO) on 15 February. Under the theme ‘All Hands In to Accelerate CureAll Implementation’ the IAEA presented its work in supporting countries in improving outcomes for children with cancer.

Cancer is a leading cause of death for children around the world. More than 400 000 children are diagnosed with the disease globally each year. The majority live in low and middle income countries (LIMCs), and have only a 20 to 30 per cent chance of survival, versus 80% in the developed world. Survival rates in LMICs are low due to delayed diagnosis, inaccessible or uncompleted treatment, or because cancer is combined with an existing condition such as malnutrition.

Radiotherapy can improve the survival of children with nine common cancers. Patients in least developed countries can only reach 37 per cent of the world’s services despite having an estimated 85 per cent of cases by 2050.

Saving a million

Since 2014, the IAEA has invested over €47 million in training and equipment for radiation oncology for cancer management, which includes support for paediatric cancer services. This complements years of assistance with over 100 countries to help plan and strengthen access to cancer care. The IAEA is now working closer with WHO in its efforts to focus attention on the youngest patients, which could help save an additional one million lives by 2030.

IAEA Director General Rafael Mariano Grossi spoke about the IAEA’s role. “One of the key roles of the IAEA is to share the great nuclear-derived breakthroughs in medical science and technology with our global family to drive up cancer survival rates,” he said. “We are raising our ambitions! We are determined to make an even greater impact through new partnerships and sponsorships. As the CureAll efforts advance, you can count on us.”

Over the last year, the joint IAEA-IARC (International Agency for Research on Cancer)-WHO review missions to countries requesting advice on their cancer care systems, – called imPACT Reviews –have been expanded to incorporate a review of childhood cancers. Read the article on the last imPACT mission to Mali.

“When a child has cancer it affects the whole family. Regrettably, the lack of public awareness and access to services mean that families only seek help when it’s too late, so only end of life care can be provided. This comes at a high cost to the children, their families and the society at large,” said Lisa Stevens, Director for the Programme of Action for Cancer Therapy. “Information and data on the scale of paediatric cancers are sometimes undocumented and unknown to Ministries of Health. imPACT Reviews provide a clear picture, so the right decisions can be made on how to get to more patients in time.”

The recommendations resulting from a Review help to identify further opportunities to build specialist capacities and the skills of health professionals, such as surgeons, nurses, technical officers and laboratory staff, to meet existing and anticipated future needs.

Building skills and providing research

Working with WHO’s Global Initiative for Childhood Cancer (GICC), which aims to ensure that 60 per cent of children will survive cancer by 2030, the IAEA participates in projects in the Eastern Mediterranean and in Zambia to promote multidisciplinary partnerships, as well as holding discussions with health planners, paediatric oncologists, surgeons, radiation oncologists and medical staff in diagnostic imaging. A ‘Paediatric Radiotherapy Service Guideline’ is being developed with international experts for use by health planners and practitioners. This document will ensure that requirements for safe and effective paediatric radiotherapy are reflected in cancer management discussions and service planning even when radiation oncology staff are not present.

As specialist skills in paediatric cancers are sparse at national levels in many countries, the IAEA has focussed on providing training and expert support regionally to reach several countries at the same time. Recent training provided for medical staff in Asia followed earlier courses in Latin America and Africa.

“Training multidisciplinary staff is an essential building block towards providing successful paediatric oncology services,” said May Abdel-Wahab, Director of the IAEA’s Division of Human Health. “The IAEA supports this effort through fellowship training in diagnostic imaging and radiotherapy. The role of research has also been crucial in the continuously evolving management of childhood cancers. The IAEA contributes through patterns of care studies as well as clinical trials and research studies that have influenced the standard of care and management of childhood cancers, with the ultimate goal of enabling young patients to go on to have a good quality of life”, she added.

Data are essential to guide activities that support interventions for children with cancer. The IAEA conducts research to assess the situation on the ground, published in documents such as the Practice of Paediatric Radiation Oncology in Low and Middle Income Countries. The data help support recommendations for where radiotherapy resources can be used to make a difference.

A virtual international conference hosted by the IAEA on Advances in Radiation Oncology (ICARO-3) is currently underway. It will include a plenary lecture on paediatric radiotherapy on 17 February and a refresher course covering multidisciplinary team working and radiotherapy contouring in paediatric radiation oncology. The IAEA is also working with Saint Jude Children's Research Hospital to assemble a virtual library of childhood cancer cases for paediatric radiation oncologists.

Nutrition support is a vital component of comprehensive care for children with cancer. The IAEA is supporting countries through a dedicated coordinated research project to utilize nuclear techniques to understand the interlinkages between cancer, nutritional status and clinical outcomes. These data will help cancer centres to improve their nutrition support programmes.

Safety first

Medical staff working with young patients require special skills when detecting, diagnosing and treating cancer to ensure that patients, as well as staff, are protected from radiation. The best imaging option, either using radiation (X-ray, CT scans) or other methods (ultrasound, MRI), need to be considered and performed at the lowest dose while maintaining the diagnostic quality of the image.

“Children are not small adults,” said Ola Holmberg, Head of IAEA’s Radiation Protection of Patients Unit. “They require specific investigations tailored to their size and needs, and only taken when required to minimize exposure and help avoid symptoms that could occur later in life.”

The IAEA provides institutions and trainers with help for safety standards, training, knowledge exchange and technical assistance to ensure all their patients, staff and the environment are protected. Assistance provided have included modules on radiation dose management for CT scans, a webinar series on radiation protection developed in partnership with the Alliance for Radiation Safety in Paediatric Imaging (the Image Gently Alliance), and with LatinSafe (in Spanish); multilanguage materials on radiation protection for medical professionals, and information for parents.

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