Paediatric Oncology

The BBC last week regurgitated old reports derived from the Eurocare programme showing much of European cancer diagnosis and care was superior to the U.K.’s. Oh for fuck’s sake you have reported on this before, especially as Eurocare’s most recent reports were published in November 2006.

(The BBC’s Health reporting goes from good to bad, bad to good – I think they need a new Health section editor – Dr Crippen/Dr Rant, who is s/he and cannot we do something about this person?).

But it did draw my attention to two deserving pieces in the latest issue of Lancet Oncology about paediatric oncology (here and here, but you will have to complete the free registration).

In the first, entitled Political momentum and paediatric oncology, the author (seemingly American) states “the increasing politicisation of paediatric oncology should bring further benefits” … couldn’t agree more, “hear, hear”!

The piece pointed to the rally that Lauren and Fergus attended at the US Congress in June supporting the proposed Conquer Childhood Cancer Act to provide USD 150 million of new funding for paediatric oncology research over five years. And the Lancet reports this has gone into a quagmire of congressional committee stages.

The second Lancet piece, UK childhood cancer survival falling behind the rest of EU?, looked at a 2001 Eurocare study of paediatric oncology care from 1978-1992, comparing paediatric care in different countries across Europe, rather than the newer 2003 Eurocare study of the period 1990-94.In both studies the U.K. remains down the lists. The 2003 report does not change the U.K.’s ranking much from the 2001 report,

Paediatric screening and therefore rapid diagnosis does seem to be a big problem – in Germany every child has a primary-care paediatrician who undertakes regular health checks.

In the UK a young child is not scheduled for a regular GP check. Maybe, if you are lucky, a “health visitor” will come and check up. We have one – and she’s great. She is the first to admit “I am not a nurse and I am not a GP” and she is certainly not a paediatric screener – she is there to help us out with social difficulties (like access to the GP, or arranging an interpreter for a GP consultation although most GPs, certainly in our geographical region, are aware of this service) or arranging someone to help us out with transport, school, shopping or immigration … so, as we cope, she just pops round for a cup of tea! To be quite honest her job title should not include the word “health”.

She is not a Health Screener and our GP, in his contract, has not been given, the job of screening every perinatal in the country .

So it is up to the GP to identify an abnormal condition when the parents take their child in with a “common” complaint,

So my GP should be screening my child … but, hey, the government didn’t put it in his/her contract …

Two statements stand out from these two Lancet pieces:

“Paediatric oncology has long been the poor relation of adult oncology: treatment developments are slow and children are often given older medicine or regimens, or drug doses adjusted from adult schema without an appropriate evidence-base.”

“Sub-optimum survival is just one of example of the worse state of children’s health care in the UK compared with many countries. The perinatal mortality rate puts the UK in the 15th position in Europe and there is clear evidence that children with diabetes are not receiving optimum care. Although there is a National Service Framework for children, which sets standards, there are no targets. Children continue to be a low priority for the NHS”.