A little learning can save little lives

It’s cruel enough to imagine a child dying of a disease. Infinitely worse is the thought of a child dying without being treated for the cause. Yet that’s exactly what will happen to a thousand South African youngsters this year as they fall victim to cancer. Why so many deaths without treatment? The plain fact is that too few of us — parents, teachers, care givers, even medical staff — are aware of the warning signs of childhood cancer. Yet those signs are generally very plain to see. If the disease is caught early enough, there is a tremendously good chance that modern therapy will cure it. If diagnosed in the early stages, seven out of ten young cancer patients can be successfully treated and grow up to live normal, healthy lives. Here are the facts:

* One child in 600 will develop life threatening cancer Worldwide
* In South Africa it is estimated that every year, 1 700 children develop cancer before the age of 15
* Of these 1 700 children, approximately 700 are diagnosed in the late stages
* 1 000 children die needlessly each year, either undiagnosed or diagnosed too late

Cancer in children is generally very different from cancer in adults. Most childhood cancers start in developing cells, like bone marrow, blood cells, kidneys and tissues of the nervous system. The blood disease leukaemia is the most common childhood cancer. Next come brain tumours, and there are numerous other types of tumours that affect children The usual treatment depends on chemoth erapy, surgery, or radiation, often a combination of two or all three. Some cases require transplants of bone marrow or stem cells. What each case has in common is that it depends on early diagnosis and expert treatment at a specialised children’s oncology (cancer) unit. These units are generally linked to the main teaching hospitals. One of the challenges is created by the therapy itself, which generally weakens the body’s natural self-defences. Children become particularly vulnerable to infections during therapy and should therefore be accommodated in a good, clean environment. The journey between home and clinic complicates most cases, adding more stress and emotional strain to the family in already overwhelming circumstances. Danone Clover is one company that is making a real difference in this regard. The ‘Caring for Our Children’ campaign each winter donates money to the CHOC Childhood Cancer Foundation and to date has built three Danone Clover CHOC houses close to children’s oncology units. These sanctuaries provide accommodation and meals for the patient and a parent, whose presence during therapy is generally the best medicine of all. The South African Children’s Cancer Study Group has prepared a list of warning signs for distribution to primary health care centres. The list has been adopted by the International Society of Paediatric Oncology (SIOP) for distribution throughout developing countries. The signs are named after Saint Siluan, a Russian monk who prayed ceaselessly for all humanity:

S is for Seek medical help early for persistent symptoms
I is for Eye, in which a white spot, new squint,
blindness or bulging eyeball calls for urgent investigation.
L is for Lump, and the abdomen and pelvis, head and neck, limbs, testicles and glands must be examined often for an unexplained lump.
U is for Unexplained fever, loss of weight and appetite, pallor, fatigue, easy bruising or bleeding , each of which demands thorough investigation.
A is for Aching bones, joints, or back as well as easy fractures.
N is for Neurological signs, especially changes in behaviour, balance, gait, and milestones, headache, enlarging head. Each of these simple signs demands immediate investigation by an expert; any delay can lead to another tragic and avoidable death.