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Case Studies

Mahak, a well known paediatric cancer charity in Iran, has been extremely successful in the fight with childhood cancer, reducing the cancer related fatalities in children, which had always been high in Iran from 80% down to 24%, which is in line with the international standards.

With this mind, epidemiological studies show that the incidence of childhood cancer is on the rise in Iran (1). Therefore one would expect that the infrastructure and facilities in Iran would have increased in line with the growing incidence of childhood cancer. However, this is not the case and not only is Mahak still the only modern and efficient centre that tackles this problem, other parts of Iran are suffering from a serious lack of infrastructure and shortage of pediatric oncologists, further discussed later.

 

The incidence of childhood cancer in Iran is significantly less than developed countries- this is due to the large number of missed and unrecorded cases (1).

According to epidemiological studies, the three most common cancers in children are leukemia, CNS tumors and lymphomas; these cancers are followed by SNS tumors, soft tissue sarcomas and renal tumors in order of frequency (2).

A drastic change in trend of childhood solid malignancies has been observed, as seen in Figure 1. The total number of cases almost doubled from 2009 (54(6.9%)) to 2010 (96(12.2%)). Such trends were particularly detected in CNS and SNS tumor categories, as shown in Figures 2 and 3 (1).

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The childhood cancer mortality rate is more than other mortality reports. The mortality among children below 1 year of age is 4 times more than other age group. The high reported mortality of childhood cancer in Iran might be due to the low education or least awareness of the parents, late diagnosis, or low access to effective treatment (2).

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While the aim of the Avicenna Project is to help tackle the issues of paediatric cancer in Iran, it would be worthwhile to consider building a centre in a province that has a considerable number of childhood cancer cases. According to the above table , the province with the highest by proportions of childhood to all cancers after Tehran is Kerman, where both the proportions of both provinces are significantly higher than the national proportion.

 

The table below illustrates the children that require treatment (categorized by different types of cancer) in Iran based on current figures.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In order to achieve a better evaluation of the situation in Kerman, we contacted individuals in the province of Kerman to get more details to support the data we had extracted from published articles.

 

Present Situation in Kerman

 

Sadly, the figures in Kerman are growing, reflective of the situation of childhood cancer in Iran. The situation within this city is exceptional as it represents the scope of the problem and shortcoming of facilities in the south east of Iran.

 

In general, in terms of medical care, Kerman covers not only the patients from the whole province of Kerman, which is the biggest province in Iran by area, but also from Sistan- Baloochestan and Hormozgan. Due to the geographical situation of central and southern parts of Iran, being all desert , the long distances add to the adversity of the situation.

 

Currently, YAS is the NGO in Kerman that is attempting to provide care for children with cancers. Mahak has also signed a memorandum of understanding with this charity to support the child patients of that region. Although considerable outcomes have been achieved by MAHAK and YAS, the problem remains unresolved and requires the development of an infrastructure to properly support the region.

 

Based on our local research, there is only one paediatric oncologist available Kerman, whom we approached for a conversation regarding the current issues.

 

According to her, who works along with about ten personnel, the patients are treated in Kerman’s Afzalipoor hospital which is governed by Kerman’s medical school. However, the conditions within which the children are treated are not appropriate.

 

Indeed there was no allocated space for children suffering from cancer and the mentioned section was created by making use of the ample free space present in the hospital. The capacity of this so called section is 12 patients along with their guardians. Furthermore, at peak times, the guardians are asked to leave in order to receive more children, filling this section to beyond its maximum capacity.

 

Moreover, this hospital cannot accommodate the patient’s guardians and ,as a consequence, they face a difficult stay during the treatment periods.

 

Among other serious concerns are lack of medical equipment and drugs. According to one of Mahak's assistants in Kerman, the number of children under coverage has increased from about 60 in August 2011 to over 160 at the time of preparation of this report, August 2012.

 

This three-fold increase in one year, although it might make us appreciate the progress in providing support, is very alarming as it hints at a frightening outcome. Currently, with this level of support, almost one child passes away every month.

 

Consequently, with regard to the aforementioned conditions in Kerman and south east of Iran, the need for development of a modern infrastructure in the provence of Kerman to address the needs of paediatric cancer is absolutely crucial and thoroughly justified.

 

 

 

References

1. Jadali, F., Aghayan Golkashani, H., Habibi, G., Rouzrokh, M., Abdollah Gorji, F., Dini, F., Khodami, M., Nilipour, Y., Khaleghnejad Tabari, A. & Sadeghian, N. (2012) Survey on Childhood Solid Malignant Tumors in Cases Admitted to Mofid Pediatric Hospital From 1996-2010: a Single-Center Study . Iran J Cancer Prev. 5 (2), 93-104.

2. Mousavi, S. M., Pourfeizi, A. & Dastgiri, S. (2010) Childhood cancer in Iran. Journal of Pediatric hematology/oncology. 32 (5), 376-382.

 

Case Study 1: Kerman, Iran

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Solutions

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