WHAT ROLE DO PEER GROUPS HAVE IN CHILDHOOD CANCER MANAGEMENT?

Earlier this year in the hustle and bustle of the Cancer Diseases Hospital, one afternoon as I was crossing from phase II to phase I, I bumped into a young man in the staff car park. His attire was clearly a secondary school uniform – white shirt, grey trousers, tie and his dusty shoes – clear evidence of his ‘mileage’. Even though he was a boy, the type of baldness was not intentional and what gave him away as a cancer patient the obvious chemo shave. Our eyes met and he grinned widely offering a greeting. His warmth and openness invited me to stop and have a quick chat with him.

I established that he was lodging in the children’s ward whilst receiving chemotherapy for his cancer. He also continued attending classes at one of the secondary schools as he was in grade nine and nothing was going to stop him from writing and passing his exams with flying colours.

I must remind you readers that I am not a children’s doctor so the resilience children and adolescents show in the face of disease is much a wonder to me as the next layman. I took the chance to ask him how his friends related to him at school. He admitted that due to his busy schedule of treatment and sometimes bouts of ill health he could not accommodate his peers into his schedule but generally he was treated well at school. I was thoroughly amused. He was accommodating them and not the other way around. What a character!

As he was clearly a mature and focused young man, I asked him what he intended on studying at university, secretly hoping it was medicine, as well as what career he envisioned himself in. He replied he didn’t know yet and that is why he settled to excel in every subject at school. I agreed with the philosophy. He also added quickly life was unpredictable and he simply lived his best a day at a time. Before his last statement sobered our lively aura, he said his goodbyes, bouncing his fragile frame along and owning each step he took.

I realised I had not found out if he was out of town or what kind of cancer he had or how far along in his treatment he was but deep in my heart I said a quick prayer for healing and success in this boy’s cancer journey.

Recently, I was part of a conversation amongst global specialists on raising cancer awareness amongst children of school going age. In particular the group from North America spoke of the negative impact that drumming of breast cancer knowledge into young school going girls may have given the incidence in this population group is negligible. The lumps found in girls that age are more related to non-cancerous processes such as fibroadenomas. Apparently this awareness causes a lot of anxiety and so on.

However, when you think of HIV/AIDS sensitization in schools, it has worked well to a certain extent with some schools even have clubs to promote participation of the youth in the elimination of this pandemic. How fragile are our children compared to their counterparts where these studies were done? Our culture and upbringing is so different. It made me think of the bright young man and his peers in the school environment. We talk about the patients and the families. How about the peers of these patients? How do they cope with interaction of this life threatening disease? The peer group in environment like ours would probably play an important in supporting a child through cancer treatment.

In another discussion, it was pointed out that survivorship guidelines for adolescents in resource-limited environments are lacking. Today they speak of high cure rates for the most common childhood cancers if they are timely managed. Are educators equipped to deal with the presence of a pupil or student who wishes to continue with mainstream school through chemotherapy? What are the perceptions of cancer? Is it regarded as a death sentence? How does one effectively facilitate the education of the said busy schedule of treatment and sick days of such a child?

Truth be told childhood cancer is not as common an occurrence when compared to other diseases as such attention to cancer sensitization is low. A Zambian study published in 2014 suggested the most common cancer found in the paediatric ward between the period of 2008 and 2010 were lymphoma, Wilm’s tumour followed by retinoblastoma. Retinoblastoma has enjoyed quite a bit attention locally in recent years. It is a cancer of the eye that can be detected quite early. Photography has been used to detect this cancer in its very early stages. The name is derived from part of the eye that is affected is called the retina, which is the ‘membrane’ at the back of the eyeball with receptors or detectors of colour. When one takes a photo in dim light usually the dark part of the eye appears red. However, when a cancer is present there is a white dot instead. This observation can literally save your child’s life. Even though it is a scary thought, retinoblastoma is highly treatable and curable when caught in time. Unfortunately sometimes the child has to lose an eyeball but prostheses are available. This cancer occurs in commonly in children under 5 years and can have some family (hereditary) links. I remember when I did my internship the children’s ward was still in A block at the University Teaching Hospital. The little children receiving chemotherapy after the removal of the eyeballs were the naughtiest and loudest running around in the sun. One morning, a major round with a well-feared consultant was dragging, one of these little patients saved our hungry tired bodies by chiding her for taking up time meant for play! We had a good laugh, needless to say the rounds finished at a much quicker pace.

As I mentioned my area of clinical expertise is far from children, but in my inevitable interaction with these little champs, I find that they have a lot to teach us about their experiences and its time we listened to them carefully. I really applaud well-wishers who bring so many things for these sick cancer children but just like everyone likes, lets take time to really get to know these children and their fears and aspirations.

 

 

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