Pediatric Palliative care in Childhood Cancer (Myanmar)

Aye Aye Khaing Yangon Children Hospital

NayPyiTaw, Mingalar Thiri 26.11.19

M

R

Myanmar is the second largest country in Southeast Asia with an estimated total population 59.13 million,U5 MR 52

2 PHO Centers 6 Paediatric hemato-oncologists

Anticipated new childhood malignancy cases 1800 to 2500 per year

Aye Aye Khaing Professor MBBS,MMed Sc(Paed),MRCPCH, Dr Med (Pead) Paediatric Hemato Oncology Unit Vice-President –Myanmar Society of Haematology

Haemato-oncology in Yangon Children Hospital, Myanmar

Sossolid

Y

58.8% 21.4%

41.6%

25.9% 25.0%

58.8%

50.0%

62.5%

33.3%

1 year Overall Survival Rate

Yangon Children Hospital Hemato –Onco Unit

Level of Supportive Care: SIOP PODC

1.Hand washing or disinfectant facilities 2. Implement nutritional assessment and nutritional support 3. Availability of oral morphine and use WHO pain ladder 4. Invest in providing social support (travel money, free board and

lodging) 5. Risk of extravasation of chemotherapy 6. a local management plan for febrile neutropenia 7. Avoid mucositis by not using toxic regimens 8. Children with HIV/AIDS and cancer can be treated like other patients

(EO) 9. Chemotherapy should not be delayed in children with TB (EO) 10. Anti-emetics (no lorazepan ) 11. Painful procedures :a separate room : proper medication 12. Blood transfusion guidelines must be adapted to local conditions

mma

• 25.11.19 YCH in patients-54 • Patients on active management -34 • Patients on palliative chemo-13 (38%) • Patients on morphine -6 (18%)

Current needs for the palliative care

Workshop Day 1 – Yangon Summit Parkview Hotel, May 5, 2016

Workshop Day 2 – Naypyitaw Horizon Hotel, May 6, 2016

National Workshop on Childhood Cancer Control Programme in Myanmar 2016

2nd NCCCP workshop, multistakeholders May 2019

Service delivery

1.Establish ward space with improved isolation capacity 2.Implement supportive care improvement program 3.Establish referral pathway

1. Ward space become 75 bedded (2 floors) but same isolation rooms (4)

2&3. Training – 4 Haemato-oncologists, 2 Pathologists, 1 Paediatric radiation Oncologist

• World Child Cancer (UK)- Training –pathologists, Med Technologists, Doctors, Nurses

• St Jude Global –Capacity building- Doctors, Nurses, National childhood cancer control plan, workshop, regular tumor board online meeting

• Childhood Cancer International: parents group, Onco-nutrition project

• Boston Children Hospital- Nurses training, Extravasation Project, Onco-nutrition project

Project o Onco-Nutrition project by a nutritionist (BCH and CCI) covered

60% of new patients. o Early Recognition of Childhood Cancer campaign – two

workshops every year at satellite centers. o Paediatric Palliative Care (PPC)

o Satellite Training Workshop for Pediatricians and nurses from networking centers (11 State and Divisional Hospitals)

• Other Activities(Psychosocial support) o Heroes School o Psycho Counselling by Clinical Psychologist

1st workshop 2017

2nd workshop June2018

3rd workshop Nov2019

2018 WHO childhood cancer initiative

• cancer is the leading cause of death for children, with 300,000 new cases diagnosed each year among children aged 0-19 years.

• Children with cancer in LMICs 4 times more likely to die and accounts for 80% of the target population.

• Increase 2 folds prioritization of childhood cancer • Double the cure rate of childhood cancer and • No more pain/ suffering of childhood cancer by

2030

mma

• ensure the right • to early and proper diagnosis • to access life-saving essential medicines • to appropriate and quality medical

treatments • to treatment without pain and suffering

and when a cure is not attainable • the right of the child to a pain-free death.

No more pain :ICCD 2019

The WHO pain ladder

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www.paineurope.com

Since 2018

The WHO pain ladder The WHO pain ladder is a framework for providing symptomatic pain relief. The three-step approach is inexpensive and 70–90% effective

By mouth The oral route is preferred for all steps of the pain ladder

By the clock Cancer pain is continuous - analgesics should be given at regular intervals (every three to six hours), not on demand

Adjuvants To help calm fears and anxiety, adjuvant drugs may be added at any step of the ladder

16

d

Less suffering

s

suffering

Aug 2012 2014 2015 2016 2013

Myanmar Training-of-Trainers Program

In-country teaching modules

• 7 volunteer faculty

• 28 trainees

F 1 F 2 F 3 F 4 F 5 F 6

National Opioid Seminar

New service Starts at YGH

Study visit

Clinical attachments

2017 2018

2019 2020 2021 2018

Myanmar Training-of-Trainers Program

Needs assessment PPC workshop

• 25 trainees

F 2 F 3 F 4 F 4 F 5 F 6

PPC training At St Jude 1 month Padiatric oncologist

PPC Workshop KKH Singapore 1

PPC training At St Jude 10 days 2 nurses

35 trainees,8 displines Oncologist Othopedic Renal Cardiac Neuro,ICU,Neonate