Overview of pediatric oncology and hematology in Myanmar

Abstract

Myanmar is a country in southeast Asia in political, economic and healthcare transition. There are currently only two pediatric oncology centers serving a population of almost 19 million children. An estimated 85-92% of children with cancer are undiagnosed or not receiving treatment. Abandonment of treatment is as high as 60%. Although a number of chemotherapy agents are available, difficulties remain concerning treatment costs, quality control and the availability of supportive care. Radiotherapy services are also limited and not usually included in pediatric protocols. Healthcare professional training, improved diagnostics, strategies to tackle abandonment of treatment and the development of a parents’ support group are major priorities. Local and international partnerships including a recent partnership with world child cancer are essential in the interim to support the development of pediatric oncology and hematology in Myanmar. A unique opportunity exists to support the development of preventive, diagnostic, curative and palliative care for children's cancer in Myanmar from the outset.

Determinants of Treatment Abandonment in Childhood Cancer: Results from a Global Survey

“…Our results show variability in the likelihood of TxA by diagnosis (high for bone sarcomas and low for Hodgkin lymphoma and Wilms tumor), with the range of this TxA likelihood and the ranking of specific diagnoses varying by socioeconomic context; a finding consistent with other studies documenting higher rate of TxA for specific diagnoses (sarcomas, retinoblastoma, etc.). [ 2 , 14 – 16 ] However, experience demonstrates that when baseline income inequalities and frequency of TxA are high, a significant number of patients with lymphoma and Wilms tumor abandon therapy. [ 17 – 24 ] For these common and curable childhood cancers, even small percentages of TxA may be significant in crude numbers.…”

“…A recent assessment of pediatric oncology centers in Myanmar showed higher TxA for retinoblastoma compared to other oncologic diseases and supported the idea that lack of specialists, radiation services, and supportive care contribute to TxA for this diagnosis in their setting. [ 14 ] Perceived poor prognosis, by parents or providers, as a result of failed communication and education strategies are emerging determinants of TxA. [ 25 , 26 ]…”

An ethical imperative: Safety and specialization as nursing priorities of WHO Global Initiative for Childhood Cancer

“…Chemotherapy is a standard treatment required to cure most childhood cancers. Nurses, pharmacists, and physicians who prepare chemotherapy, as well as hospital support personnel (e.g., cleaners and waste management staff) and families who are exposed to chemotherapy and hazardous waste, face immediate and long‐term health risks, including cancer, miscarriages, and infertility . Adverse effects from hazardous drug exposure are entirely preventable with proper use of PPE for chemotherapy administration and biosafety cabinets for preparation, especially in settings without closed system transfer devices for chemotherapy administration as mandated in many HIC …”

Pediatric Solid Tumor Care and Multidisciplinary Tumor Boards in Low- and Middle-Income Countries in Southeast Asia

“…Although Southeast Asia has been the scene of substantial pediatric cancer initiatives in recent years, 1 - 4 the profile of pediatric cancer care resources in the region has not been well studied. With a total population of 668 million, the region is home to 8.5% of the global childhood population age ≤ 14 years, with approximately 16,000 new cases of childhood cancer annually and the third highest rate of childhood cancer mortality worldwide, after Western and North Africa.…”