WHO Global Initiative for childhood cancer – India responds

A Systematic Review of Experimental Studies on the Impact of Empowerment-Based Interventions on Child and Parent Outcomes in the Pediatric Oncology Setting

Background

Cancer has an impact not only on children but also on parents. Parents play the most crucial role in cancer's symptom control and management. However, as the primary caretakers, parents are frequently unprepared or engage in inappropriate behavior when caring for their children. Increasing parents' role through empowerment is critical in pediatric cancer care.

Purpose

This systematic review aimed to identify the effect of empowerment interventions on parent and child outcomes in pediatric oncology.

Methods

In this review, studies published between 2013 and 2023 in The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Medline, and Scopus databases were identified using a search strategy to identify relevant studies that determined empowerment-based intervention for parents in the pediatric oncology. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies. This systematic review followed the recommended reporting items for systematic reviews and meta-analysis (PRISMA) standards.

Results

Seven studies met the inclusion criteria: four randomized and three non-randomized experimental studies. Children range in age from 1-14 years. The intervention is mostly delivered through face-to-face learning using booklets or modules as a learning tool. The intervention is delivered in 2-6 sessions over 1-8 weeks, lasting 20-45 minutes each. In most studies, the interventions positively affect parents' outcomes (knowledge, caring behavior, distress, care burden, quality of life) and children's outcomes (oral mucositis, gastrointestinal complications, quality of life). The intervention, however, has no significant effect on the coping style. Barriers to implementation include parent-nurse commitment, the retention of parent-nurse participation, and more time spent to provide interventions.

Conclusion

Our study highlights that empowerment-based interventions positively impact parents and children. These findings suggest that an empowerment-based intervention should be developed to provide better cancer care for a parent and their children.

Systematic Review Registration

PROSPERO registration number was CRD42023422834.

An assessment of childhood cancer care services in India - gaps, challenges and the way forward

Background

Childhood cancers are emerging as an essential concern in India where there is lack of a specific programme component or policy to address childhood cancer control. There is limited information on the status and quality of childhood cancer care services in India. This paper describes the childhood cancer care services available at secondary and tertiary-level hospitals in India through a cross sectional study design.

Methods

The survey was conducted in 137 tertiary-level and 92 secondary-level hospitals in 26 states and 4 Union Territories (UTs), ensuring a uniform representation of public and private care hospitals. The study tool collected data on the organisational infrastructure, type of oncology services, health workforce, equipment, treatment and referral protocols, and treatment guidelines. Descriptive statistics was used to primarily present the health service status and data on childhood cancer care services in proportions and mean.

Findings

A dedicated pediatric oncology department was available in 41.6% of the public, 48.6% of private, and 64% Non Government Organization (NGO) managed tertiary-level hospitals. In 36 (39%) of the 92 hospitals providing secondary care, childhood cancer care was provided. The availability of bone (41.5%) and positron emission tomography (PET) scans (25.9%) was lower in public tertiary hospitals, whereas histopathology, computerised tomography (CT scan), and magnetic resonance imaging (MRI) were lower in public secondary hospitals than private and NGO managed hospitals for the corresponding level of care. Most tertiary hospitals had the required supportive care facilities except for play therapy and hospice care. Less than 50% of the public tertiary hospitals had stocks of the four categories of cancer-treating drugs and essential infrastructure for radiotherapy and chemotherapy. Most secondary-level hospitals not treating childhood cancer had referral linkages with tertiary hospitals.

Interpretation

The situational analysis of childhood cancer care services in India showed the concentration of availability of childhood cancer care services at the tertiary level of health care. There were gaps in the availability of specialised pediatric oncology care in all the tertiary hospitals. The availability of childhood cancer care services was higher in private and NGO-managed hospitals than in public hospitals. Integration of childhood cancer as a part of the national cancer control response should be taken up as a matter of priority. The need of the hour is to formulate a childhood cancer policy that will enable timely access to care universally.

Funding

World Health Organization, India provided funding and technical support.

Building a Foundation for the Care of Children with Cancer in Rural North India

One of India's biggest challenges is to improve its global standing by increasing healthcare access and outcomes for children with cancer, with inferior overall survivorship compared with its Western counterparts. In conjunction with the government's efforts, private enterprise is crucial in delivering optimal cancer care consistently to its vast and diverse pediatric population, despite existing limitations. This article describes the successful implementation of a value-based, collaborative clinical and research framework by a philanthropic foundation in a rural Northern Indian city to establish and run a local childhood cancer service. It is proof of concept that substantial change could be brought about at grass roots level through resourceful partnerships and reduce prevailing imbalance in pediatric oncology service provision.