The Government of Nepal plans to target and tackle childhood cancer as a first step in its broader cancer control efforts. It has invited experts from the IAEA and its partners to provide advice on how to increase access to cancer care and lower the annual cancer-related death toll of 14 000 mothers, fathers, sisters, brothers, daughters, sons, in the country. An international and local team of experts has recommended a number of areas to strengthen the health system for childhood cancer, - which is highly curable, – including data registration, diagnosis and treatment services, as well as palliative care. The implementation of these recommendations will lead to long-term strengthening of the cancer control programme in Nepal, reducing fatalities, government officials have said.
The experts were part of an imPACT Review, aimed to support Nepal in addressing its cancer burden, as the new cancer cases and mortality rates continue to increase each year. Leading specialists from the IAEA, the World Health Organization (WHO), and the International Agency for Research on Cancer (IARC), along with a team of international and local cancer experts, carried out the review in response to a request by the Ministry of Health and Population for a comprehensive assessment of the country’s national cancer control capacities and needs.
The review concluded that one of the key steps in better understanding the scale of the childhood cancer problem in Nepal is to focus on data – and target care accordingly. The data comes from cancer registries in communities and health records in hospitals, and helps to identify the most prevalent cancers across different regions of the country. Priority areas of intervention can then be determined. The review recommended that Nepal strengthens its registration and surveillance system, in particular childhood cancer registration. Once such systems are in place and functioning well, Nepal will be better positioned to strengthen its overall cancer control programme.
Nepal has been designated as a focus country in the WHO Global Initiative for Childhood Cancer, alongside Myanmar and Sri Lanka in the WHO South-East Asia Region. The Initiative is guided by the CureAll framework, which provides a strategic and practical approach and drives participating countries to recognize and act on the social and economic value of investing in childhood cancer. Simply put, the CureAll framework supports countries to save lives in a cost effective way.
“Childhood cancers are highly curable and Nepal is well positioned to improve outcomes and prevent unnecessary suffering and deaths,” said Catherine Lam, Co-Director of the WHO Collaborating Centre for Childhood Cancer and Director of the Health Systems Unit at St. Jude Children’s Research Hospital. “There is a great opportunity to build on the strong core services being provided, and have these services be coordinated as part of an essential package that covers diagnostics, treatment and support to ensure that children successfully complete therapy, whether they are in the Kathmandu valley or live more than a day’s travel away.”
“The St. Jude Global Alliance, with more than 125 member institutions around the world, looks forward to supporting the Nepalese community, and working together towards the CureAll targets to achieve at least a 60% survival rate in six common childhood cancers by 2030, while strengthening supportive and palliative care to reduce suffering for all,” added Lam.
Globally, disparities in access to cancer care remain a challenge: 80% of children with cancer will survive in high-income countries, a ratio that is only about 20% in low and middle-income countries. Such inequity is also present within Nepal’s borders where access to cancer care is much greater in the Kathmandu valley than in other parts of the country. Furthermore, it is estimated that about a quarter of cancer patients in Nepal do not complete their planned therapy due to financial constraints.
“A comprehensive approach needs to be adopted to enhance access to early diagnosis and treatment services for children with cancer,” said Guna Raj Lohani, Chief of the Policy Planning and Monitoring Division at Nepal’s Ministry of Health. “As a follow up from the imPACT Review, our Government will formulate the new National Cancer Control Programme to ensure a holistic and multi-disciplinary approach to cancer control and prioritize childhood cancers. We will continue working together with our UN partners – the IAEA, WHO and IARC to accomplish this objective.”
As part of the imPACT Review, ten international experts conducted virtual visits to seven health facilities in the country. They met with a team of national experts, designated by the Ministry of Health and Population, across all areas of cancer control. “The multidisciplinary team of experts from different institutions involved in the review contributes to a stronger collaborative network on cancer control efforts in the country,” said the WHO Representative in Nepal, Rajesh Sambhajirao Pandav. “The goal is that this network continues to develop long after the review is finished.”
The imPACT Review provides a comprehensive and baseline situation analysis for cancer care with a specific focus on low- and middle-income countries where many cancer death could be avoided. Based on review’s recommendations, the IAEA, IARC and WHO continue to support Member States in the formulation of National Cancer Control Programmes and in the development of cancer related projects and resource mobilization.
Key recommendations included:
- Strengthen the cancer registration and surveillance system, including childhood cancer registration
- Strengthen cervical cancer screening, in particular using the screen and treat approach
- Increase awareness and clinical examination for the early detection of breast cancer
- Reinforce diagnostic services and ensure a well-established referral system
- Upgrade existing infrastructure and equipment, including ultrasonography, digital mammography and CT scan
- Strengthen laboratory and pathology services, especially for the most prevailing cancers and highly curable childhood cancers
- Develop an essential medicine list including at least 85% of the drugs available in the WHO Essential Medicine Lists to increase access to oncology drugs
- Develop mass anti-smoking campaigns especially in schools
- Include the HPV vaccination in the national immunization schedule
- Develop a robust and evidence-based National Cancer Control Programme (NCCP)
- Include a national plan for the development of radiotherapy in the NCCP
- Establish national guidelines for common childhood cancers as well as national referral mechanisms to ensure continuity in treatment.
