BPKMCH | ANNUAL REPORT - 2018

DEPARTMENT OF MEDICAL ONCOLOGY

PEDIATRICS ONCOLOGY UNIT

Introduction

The Pediatric Oncology Unit takes care of wide variet es of malignancies in children and adolescent, includes

pat ents up to 19 years. We treat more than 300 new pat ents with a different type of pediatric malignancies

each year. In 2018, we received and diagnosed 299 newly diagnosed cancer pat ents. We get pat ents referred

from hospitals located throughout Nepal and other neighboring countries. Diseases we treat include both

hematological malignancies such as acute leukemia’s (ALL, CML, AML) and malignant lymphomas (Hodgkin’s

and Non Hodgkin’s lymphoma), and solid tumors such as sof t ssue sarcomas like Rhabdomyosarcoma,

Neuroblastoma, Nephroblastoma, Ret noblastoma, Hepatoblastoma, Germ cell tumors, bone tumors like

Ewing’s sarcoma family of tumor, Osteosarcoma, synovial sarcomas, tumor from head and neck regions, GI

malignancies and CNS tumors.

Based on the heterogeneity of the disease spectrum, we have built up a mult disciplinary network with

other divisions, such as surgery (including orthopedic surgery, ENT head and neck surgery, thoracic surgery,

neurosurgery, urosurgery, colorectal surgery, gynecological surgery and GI &Hepato-billiary surgery), radiat on

oncology, radiology and pathology.

Treatment Approach

The common approach to the diseases is "risk adapted therapy" regarding the long-term life expectancy.

Pat ents with solid tumors receive mult disciplinary therapy, including surgical removal of the tumor, radiat on

therapy and chemotherapy as indicated. Pat ents with hematological malignancies usually receive induct on

or re-induct on chemotherapy first. Then, they are assigned either to chemotherapy course or referred to

BMT/SCT based on the risk of the disease.

Table 1: New cancer cases diagnosed at pediatric oncology unit in 2018

Diagnosis

Total

Diagnosis

Total

A. leukemia

Synovial sarcoma

ALL

Spindle cell neoplasm

AML

Rhabdomyosarcoma

CML

PNET

Biphenotypic

Neurofibrosarcoma

Unclassified

E. Head & Neck Cancer

B. Lymphomas

Nasopharynx/cavity

Hodgkin’s

Carcinoma parot d

NonHodgkin’s

Maxillary sinus

C. Pediatric solid tumor

Ca Thyroid

Nephroblastoma

Buccal mucosa

Neuroblastoma

Ca tongue

Hepatoblastoma

Others

Ret noblastoma

F. Brain tumor

GCT(ovary)

Glioma

Seminoma(YST)

Medulloblastoma

D. Sarcomas

Ependymoma

Osteosarcoma

GBS

Ewing’s sarcoma

Unclassified

BPKMCH | ANNUAL REPORT - 2018

Diagnosis

Total

Diagnosis

Total

G. Miscellaneous

GI tumors

Cervix/uterus

GIST

Thoracic/mediast nal

Adrinocort cal tumor

Pancreat c tumor

Hist ocytosis

Rectum/anal canal

Breast Tumor

Orbit

Total

299

Services

Outpat ent services

The pediatric outpat ent service opens every day to see new & old pat ents and provide follow-up

treatment to pat ents who have completed intensive treatment course. The pediatric and adolescent

specialist/oncologist and medical officer discuss various issues in pediatric inpat ents on round on a

daily basis. Pat ents undergo various procedures in a t mely manner, somet mes under intravenous

sedat on. These procedures include diagnost c bone marrow aspirat on/biopsy, central venous catheter

placement, and lumbar puncture/intrathecal chemotherapy. Difficult and diagnost c dilemma cases were

discussed in tumor board and present in morning conference, mainly to make decision and individual

treatment plan. In 2018 we have seen 12905 pediatrics pat ents in outpat ents' clinic, 9789 were

proceed though pediatric and adolescent unit and remaining were processed from different others unit.

413 pat ents were admited under pediatric and adolescent oncology unit to receive different types of

chemotherapy and support ng care, 42 pat ents were admited to receive support ve and palliat ve care

in hospice, 304 pediatrics pat ents got admited in different others unit for various treatment,

3039

services were provided through day care unit.

Table 2: Newly Diagnosed Cancer at Paediatrics oncology Unit (Age-wise) 2018

Age group

0-4 year

5-9 year

10-14year

15-19 year

Total

Numbers

299

Percentage

20.40%

23.07%

27.42%

29.09%

100%

Table3: Outpat ents Paediatrics Pat ents Atended in Pediatrics oncology unit (2018)

New pat ents

Follow up Pat ents

Unit

Grand Total

Male

Female

Total

Male

Female

Total

Pediatrics

530

401

931

5843

3015

8858

9789

Inpat ents Services

We have a total 30 days in paediatc oncology unit. On an average we have around 25 inpatents every day.

Around 10 patents received chemotherapy in day care basis every day on day care centre in close supervision

of pediatric oncologist. A special nursing care system is developed in the ward, this helps children and young

patents and their family physically and psychologically. Nurses provide appropriate informaton to help

patents and their families to keep their ideal relatonship. We also have pediatric palliatve care service

from Pediatrics outpatent clinic. Children who need prolong supportve care, we are providing palliatve

and hospice care.

Table 4: Hospital admissions in Paediatrics Oncology Ward 2018

Hematology Ward

Malignancy

Admission

DOPR

Mortality

Remission/discharge

ALL

Leukemia

AML

CML

Solid tumors

310

297

BPKMCH | ANNUAL REPORT - 2018

Causes of Mortality in pediatric hematology ward were sept cemia seven, renal failure two and respiratory

failure one. Pediatric oncology and hematology alloted beds are almost full. We are trying to borrow beds

from other units and department to get admission for chemotherapy and other care on t mely manner. St ll

pat ents have to wait for 1-2 week to get admission for chemotherapy.

Procedures in Pediatrics Oncology Unit 2018

We are carrying out many procedures in outpat ent's basis in Minor Operat on Theater (Lumber

puncture, bone marrow aspirat ons, biopsies and others diagnost c procedures), as well as day care

centre (Intrathecal chemotherapy, Lumber punctures etc). We do have many procedures in pediatric

and hematology wards (diagnost c and therapeut c). We have many procedures in Major Operat on

Theater with help of Anesthet st team to carry our procedures like Biopsy, Bone marrow aspirat ons etc

in neonate, infants, child, as well as older children who are not co-operat ve.

Paediatrics Procedures done in Wards 2018

BMA: 263

ITM:669

Academic Activities

The pediatric and adolescent specialists also join in the academic meet ngs for educat onal purpose such

as the Hemato-oncology Journal Club, CME in different departments, topics review by MD resident in

the department. We started to have collaborat on in different medical colleges( Nat onal medical college

Birgung, Lumbini medical college Tansen, Palpa Universal medical college Bhairahawa, College of medical

sciences Chitwan etc) to have exposure of MD resident in pediatric oncology and exposure in pediatric

oncology to MBBS interns. We are running intra/interdepartmental academic act vit es like topic review,

journal club, cases presentat on and CME regularly to create more academic environment Nepal Paediatrics

Society (NEPAS) is conduct ng regular CME and our department act vely involved in those monthly CME

both in Bharatpur and Kathmandu.

Dr. Krishna Sagar Sharma, MD, has successfully completed the training on EPEC (Educat on on palliat ve and

end of life care) India online Module and face to face training and workshop atended at AIIMS, Delhi from

23- 25 February 2018 .

Appointment:

1. Dr Krishna Sagar Sharma was appointed as execut ve board member of G P Koirala Nat onal respiratory

centre, Dulegaula, Tanahu by MOH.

2. Elected as execut ve board member, SAARC Federat on of oncologists-Nepal (2018-2020) from SFON

Convent on at Radisson hotel, Kathmandu, Nepal.

Research Activities

We are doing descriptve type of study in different diseases (Leukemia and lymphoma, sof tssue tumor, bone

tumor, Wilm's tumor, GCT, etc).

Hospital-based incidence in Nepal and treatment outcome in our setup. "The clinical outcome of patents afer

sequental and concurrent chemo-radiotherapy in Ewing sarcoma family of tumors (ESFOT) at BPKMCH" (NEWS)

research actvites is finished in 2018.

Conferences/Seminar Attended in 2018

Dr. Krishna Sagar Sharma, MD, head -Pediatric oncology atended following conference, workshop and training in

2018.

1. Atended the Annual conference of Indian associat on of palliat ve care at AIIMS, New delhi, India

from 23-25 February, 2018.

2. Part cipated to the implementat on strategic Meet ng for Nat onal palliat ve care policy at

Kathmandu, organized by NAPCare, MOH and Two world cancer collaborat on at Kathmandu In feb

2018.

3. Part cipated in 12th St Jude Viva Asia Preforum workshop on 8^th March 2018, at NUHS Singapore.

BPKMCH | ANNUAL REPORT - 2018

4. Part cipated in 12th St Jude Viva Asia BMT Spring School on 9^th March 2018, at NUHS Singapore.

5. Part cipated in 12th St Jude Viva Forum on 10^thto11^th March 2018, at Shangri-La hotel, Singapore.

6. Atended 1^st st. Jude Global Alliances for pediatric cancer, meet ng and work shop at St Jude children’s

Hospital Memphis, tenses, organized by St, Jude Global from 6 to 8 December, 2018, USA.

Human Resources

Dr. Krishna Sagar Sharma, MD, Unit Chief, Pediatc Oncology Unit.

Dr. Niva Tiwari, MD, Registrar.

Medical officers: Dr. Subash Mahaseth (MBBS) and Dr. Basant Pant (MBBS) were working as medical officer in

early 2018. Dr. Achyut Bhatarai (MBBS) joined in pediatric oncology Unit since early 2018.

There are trained senior nursing officer, Nursing officer, senior staff nurse and nurses are provide services to

pediatric and adolescent pat ents in oncology ward, Hematology ward, day care and assist in minor OT and

major OT procedures as well as hospice and palliat ve care ward for needy pat ents.

Future Plans

To established separate pediatric oncology and hematology ward for children with cancer along with

play area.

To establish BMT and SCT centre in BPKMCH.

To upgrade pediatric palliat ve care services with pediatric palliat ve care training facilit es.

To start academic programme and training in pediatric oncology.