Introduction
Cancer is a rare event in the pediatric population with an estimated
280,000 new cases reported in 2020 among children and adolescents
globally according to the International Agency for Research on Cancer
(IARC). Yet it’s one of the major causes of death. It accounts for over
100,000 deaths globally before the age of 15 with a majority of them in
countries with limited resources1. Most low and middle
income countries (LMICs) do not collect data on the incidence and
prevalence of cancer in the younger population thus the exact cancer
burden, which can vary according to geographical regions, is unknown. In
Pakistan, it is estimated that around 8000 children are diagnosed with
cancer each year2 which accounts for almost 10% of
all reported cases for cancer in the country3.
In the absence of a national pediatric cancer registry in Pakistan, data
can only be obtained from studies reporting regional cancer incidence
through hospital based cancer registries4. Hence,
planning of tailored national anti-cancer health policies and awareness
campaigns is limited. This could be especially useful considering LMICs
have a higher mortality compared to incidence for several cancer types
therefore after prevention strategies, early detection and better
treatment options would help decrease the cancer burden.
Several hospital based cancer registries exist in Pakistan such as
Karachi Cancer Registry (for adults) and Punjab Cancer Registry
maintained by Shaukat Khanum Memorial Cancer Hospital and Research
Center. These collect clinical data and provide essential information to
track incidence of cancer cases and the patterns of cancer care plans
available over time that can be utilized to improve the quality of care
and eventually, to form the basis for coding, summarizing and analyzing
population based studies. Environmental and genetic risk factors can
also be detected to help identify and develop preventive strategies.
They can also be used to assess implementation of standard guidelines
and evaluate outcomes of protocols including long term effects of cancer
treatment for a more tailored treatment approach since clinical practice
guidelines, such as those provided by Children’s Oncology Group (COG),
International Society of Pediatric Oncology (SIOP), National
Comprehensive Cancer Network (NCCN), European Society for Medical
Oncology (ESMO) and American Society of Clinical Oncology (ASCO), etc.
that are available to standardize cancer care, are often adapted
according to local evidence and patient outcomes.
This paper aims to report local data about the pediatric cancer patients
presenting to Aga Khan University, Karachi’s largest tertiary care
hospital and one of only five hospitals providing care to pediatric
cancer patients in the province of Sindh. Since patients come to AKUH
from all over the province for quality and specialized care, this
registry can potentially provide an estimate of the epidemiology of
cancer in Sindh. Data can also be consolidated with cancer cases from
the other hospitals in the province equipped to deal with pediatric
cancer to form a consolidated population based registry for this region.
This would ultimately help with more streamlined research of causes and
introduction as well as implementation of childhood cancer control
practices.