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Ewing sarcoma: Hope in Guwahati?

X-ray of the left knee joint. Ewing sarcoma, lymphoma, myeloma thigh bone.
An X-ray of the left knee joint affected by Ewing sarcoma. Image credit: Vitaly Dianov / 123rf

Reports suggest that children afflicted by Ewing sarcoma in the Dr B. Borooah Cancer Institute (BBCI) in Guwahati – Assam’s largest city – show a five-year survival rate of sixty percent.

Ewing sarcoma, as explained by Johns Hopkins, “is cancer that occurs primarily in the bone or soft tissue. While Ewing sarcoma can develop in any bone, it is most often found in the hip bones, ribs, or long bones (e.g., femur (thighbone), tibia (shinbone) or humerus (upper arm bone)). It can involve the muscle and the soft tissues around the tumour as well. Ewing sarcoma cells can also metastasise (spread) to other areas of the body, including the bone marrow, lungs, kidneys, heart, adrenal glands and other soft tissues.” It is most common in children and young adults.

In India, research published in 2018 indicated that “Ewing sarcoma comprised around 15 percent of all bone malignancies. Sixty-eight percent were 0–19 years, with 1.6 times risk of tumour in bones of limbs as compared to other bones. The highest incidence rate (per million) was in the 10–14 years age group (male −4.4, female −2.9).” 

The news from BCCI is welcome, but belies a broader problem with the socioeconomic inequities inherent in Indian healthcare. Fewer than twenty percent of children who were unable to complete treatment for Ewing sarcoma survived for more than a year – a statistic Kangkan Kalita of TNN ascribes to “various socio-economic factors.” Kalita writes that “patients who completed their treatment protocol had a better survival rate (sixty percent) as compared to those who defaulted or refused treatment (fourteen percent)”, whilst noting that “the study done with patients attending paediatric cancer OPD [outpatient department] of BBCI from 2013-2017 have shown that there was no significant difference in survival between patients with below and above poverty lines.” 

BCCI’s Dr Munlima Hazarika, a professor of medical and paediatric oncology, said “87 percent of patients we treated with an intention to cure. Others came in a very advanced stage and could not be saved, although paediatric [Ewing] sarcoma is a curable malignancy.” She said “these types of bone cancers are potentially curable, provided patients complete their planned treatment protocol…awareness among general practitioners about this entity is needed for early diagnosis and referral for treatment.”

Childhood cancer is a significant public health challenge. As previously reported by Health Issues India, “by 2050, the world is expected to register 13.7 million new cases of childhood cancer – and without scaling up investments, cancer will kill 11.1 million children…childhood cancer in countries at lower levels of economic development account for the overwhelming majority of cases – more than 82 percent – and consequently account for almost 9.5 million years of healthy life lost.” India is among the countries most-affected by childhood cancers such as Ewing sarcoma – addressing it is a public health imperative. 

“The stark reality is worldwide inequity and a bleak picture for children with cancer in low- and middle-income countries,” said Dr Ramandeep Arora of the Max Super-Speciality Hospital in India and a co-author of a landmark report published by The Lancet Oncology Commission earlier this year. “So far investment targeted to childhood cancer in developing countries has been minuscule. Yet childhood cancer is no longer complex, expensive, difficult to diagnose, or complicated to treat. Outcomes for children in low- and middle-income countries could be dramatically improved by addressing key issues such as delayed diagnosis and lack of access to essential medicines.”

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