Pediatr Blood Cancer 2007;49:397

COMMENTARYPediatric Hematology and Oncology in India

Rapid strides in the diagnosis and management of childhood

cancers and blood diseases have been made in the west in the past

three decades. It is encouraging that some of this global success has

positively affected India. ‘SIOP 2007,’ the 39th Congress of SIOP at

Mumbai, an important milestone for India, provides an opportunity

to take stock of the progress made so far in this field in India.

EARLY MILESTONES

The first specialized service in India for diagnosis of thalassemia

in children was instituted by the late Dr. S. M. Merchant at B.J.

Wadia Hospital for Children (BJWHC), Mumbai in the 1970s.

Dr. Zinet Currimbhoy expanded this service into the first department

of pediatric hematology & oncology at the BJWHC in 1984.

Dr. M.R. Lokeshwar set up a similar service at the Sion Hospital in

Mumbai during the same time. The Tata Hospital, a regional

cancer center, established a separate pediatric oncology unit for the

care of childhood malignancies in the 1980s under Dr. S.H. Advani.

In addition to these three specialized units in Mumbai, centers

were also established at Chennai, Delhi, Chandigarh, Bangalore,

Ahmedabad, and Trivandrum. However, pediatric hematology and

oncology does not as yet claim a separate existence in many of our

medical colleges or private hospitals. Consequently, most children

with blood diseases and cancer are still being diagnosed and treated

by adult hematologists and oncologists.

THE ROLE OF IAP

In 1987, the silver jubilee year of the Indian Academy of

Pediatrics (IAP) subspecialty chapters were initiated. Dr. M.R.

Lokeshwar was the first ‘Convenor’ of the Pediatric Hematology and

Oncology (PHO) chapter of IAP. With the help of other colleagues, he

advanced the Chapter’s initiatives and accomplishments. Many

conferences and workshops on the subject were held, CME sessions

and educational programs were conducted, a newsletter was publish-

ed regularly (PHO Review), fellowships and awards for postgraduates

and pediatricians were instituted, and teaching slides were developed.

Mumbai can boast of the first national conference of pediatric

hematology & oncology (PHOCON) held in November 1997

organized by myself and Dr. Rashmi Dalvi. In the same year, The

PHO chapter of IAP, in collaboration with SIOP, started the Indian

National Training Project (INTP). Workshops in practical pediatric

oncology are organized to train pediatricians, pediatric surgeons, and

postgraduates in the early recognition of childhood malignancies and

to prepare them for ‘shared’ care of these children. Under the aegis of

INTP, a group of about 50 pediatric oncologists have trained more

than 1,000 pediatricians over the past 10 years. In 2002, this endeavor

was recognized with a SIOP award. Establishment of clinical practice

guidelines by IAP on the management of common hematological and

oncologic diseases (ITP, Thalassemia, ALL, Aplastic Anaemia,

Lymphomas) for the benefit of practitioners is ongoing. ICON (Indian

Cooperative Oncology Network) and INCTR (International Network

for Cancer Treatment and Research) support clinical trials for

management of childhood cancers at several centres.

WHAT MORE CAN BE DONE ?

The demand for better care is increasing. To meet this challenge,

medical colleges and private hospitals in the country need to

establish more pediatric hematology and oncology units [1].

Establishment of more facilities would mean requirement of

qualified specialists in pediatric hematology and oncology. To

achieve this the National Board of Exams (NBE) has initiated

this year a national postdoctoral fellowship training program in this

field. Three centers at Mumbai and Delhi have been recognized and

the first group of students for this 2-year course has enrolled.

A crucial limitation to the progress of pediatric hematology and

oncology care is the lack of resources and funds. The most promising

opportunity to tackle this resource challenge comes from the parents

and volunteers and from their co-operation with health professionals

[2]. We need to harness the power of parent groups and associations to

raise funds for our specialized efforts. Organizations like ‘Thalasse-

mia India Federation,’ ‘Hemophilia Federation (India),’ Cancer

Patients Aid Association (CPAA), and Make-a-Wish Foundation are

already doing this. We can promote these efforts by advising parents

to join hands in these ‘self-help’ groups to minimize the financial,

social and psychological burden of these chronic disorders.

We also need to consolidate our research activities. Considering

that more than one-third of country’s population is below 15 years

of age, approximately 400 million children, the incidence of

hematological and oncological diseases is enormous. Clinical

research by collaboration & co-operation to provide cost effective

solutions for these illnesses is our most pressing need.

CONCLUSION

We are taking slow, small, but purposeful steps towards

improving in the field of pediatric hematology/oncology. High

standard of patient care services, programs for training of fellow

colleagues and continuing research by collaboration for optimal low

cost solutions should be the basis of our efforts for the future.

Bharat R. Agarwal, MD, DCH, DNB, MNAMS*

Chairman PHO Chapter of IAP

Head, Department of Pediatric Hematology

Oncology & Immunology, B.J. Wadia Hospital for

Children and Institute of Child Health and Research Center

Parel, Mumbai, India

REFERENCES

1. Agarwal BR, Dalvi RB. Treatment of childhood leukemias in

underprivileged countries. In: Pui CH, editor. Treatment of acute

leukemias: New directions for clinical research. Current clinical

oncology series. New Jersey: The Humana Press Inc.; 2003.

pp 321–329.

2. Barr RD, Ribeiro RC, Agarwal BR, et al. Pediatric oncology in

countries with limited resources. In: Pizzo PA, Poplack DG,

editors. Principles and practice of pediatric oncology, 5th edition.

Philadelphia: Lippincott Williams and Wilkins; 2007. pp 1604–1616.

� 2007 Wiley-Liss, Inc.DOI 10.1002/pbc.21340

——————*Correspondence to: Dr. Bharat R. Agarwal, Chairman, PHO Chapter

of IAP, Head of Department, Department of Pediatric Hematology,

Oncology & Immunology, B.J. Wadia Hospital for Children and

Institute of Child Health and Research Center, Parel, Mumbai, India.

E-mail: parul@bom5.vsnl.net.in

Received 17 July 2007; Accepted 17 July 2007