4 of 5 Indian children do not survive cancer. What led to this sorry state?

India has the highest prevalence of childhood cancer which can be traced to its higher population of young people, 30 per cent of its population is below 14 years, according to 2011 Census.

How long does a cancer diagnosis take?

Six months, according to Bipin Jana, 45, whose eight-year-old son Parmeshwar has stage-4 Hodgkin’s lymphoma. That is how long it took the family, travelling 2,000 km across West Bengal, New Delhi and finally, Mumbai, to get an effective diagnosis and start treatment.

Parmeshwar is currently undergoing chemotherapy at the Tata Memorial Hospital (TMH), Mumbai, India’s foremost cancer treatment centre. Almost half (43.6 per cent) of the children with cancer admitted here had to travel over 1,300 km to reach the hospital, records showed. Up to 10 per cent travelled over 2,200 km and 20 per cent had undergone alternative or incomplete treatments before reaching TMH.

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With timely diagnosis, children with cancer have a high rate of survival. If he lived in a high-income country, Parmeshwar would have had a 90 per cent chance of recovery. Since he is being treated, his odds are still better than India’s national survival rate for juvenile cancers--less than 20 per cent, according to the World Health Organization.

Worldwide, most children with cancer are from low- to middle-income countries and have poor survival rates, showed the study published in The Lancet Oncology, a global journal, in July 2019.

India has the highest prevalence of childhood cancer which can be traced to its higher population of young people, 30 per cent of its population is below 14 years, according to 2011 Census.

In order to understand why most children with cancer in India do not survive five years, IndiaSpend interviewed patients, non-governmental organisations and doctors. Delays in diagnosis, high medical expenses and non-completion of treatment are significant reasons, we found.

Survival rate can be 70 per cent with timely care

About 50,000 Indian children between 0-19 years of age suffer from cancer each year, according to The Lancet study we mentioned. “However we think the actual figure is closer to 75,000,” said Girish Chinnaswamy, head oncologist at the TMH.

Approximately 20,000 children remain undiagnosed and untreated and their survival rate is 0 per cent, he said. “For the 55,000 who are accessing treatment, 15,000 are receiving a good standard of treatment with trained oncologists as well as social, dietary and financial support and this group has a survival rate of 70 per cent,” he said.

Bihar population problem: 94% women know about contraception, 20% use them

In roughly five years, or by 2024, the population of India is expected to surpass that of China, according to a 2017 United Nations (UN) projection.

Married early, Premlata Devi had had four children by the time she was 24 years old--a boy and three girls. A homemaker from Tikari block in southern Bihar’s Gaya district, she had had a copper intrauterine device (IUD, the most common brand name being Copper-T) inserted for contraception after the birth of her second child.

Six years later, she had got it removed because of abdominal pains and increased uterine bleeding, both known side-effects of the device. “I no longer want to use Copper-T,” she said.

After the removal of the IUD, Premlata Devi went on to have two more children that she had not planned for. Neither she nor her husband know of alternative methods of contraception, she said. And the health workers, who under the National Health Mission are supposed to counsel women like her, never did show up.

Stories like these are common in Bihar, India’s fifth poorest state and third most populous, with India’s highest total fertility rate (TFR)--3.4 children per woman, according to 2015-16 government data, the latest available. This TFR exceeds that of India’s most populous states: Uttar Pradesh (2.74) and Maharashtra (1.87). The national average is 2.18. (Sikkim and Kerala had the lowest TFR for 2015-16: 1.17.)

In roughly five years, or by 2024, the population of India is expected to surpass that of China, according to a 2017 United Nations (UN) projection. China’s population will peak at 1.44 billion in 2029 and then start declining.

Due to what is called population momentum--a higher proportion of people in the reproductive age group--as well as higher life expectancy, India’s population will only peak in the 2060s, before it starts to decline, according to current estimates.

However, Indian fertility rates are declining, and some of these estimates are revised constantly. For example, according to earlier UN estimates, India was to overtake China in 2022. Ten years ago, India had a TFR of 2.68; today, according to the National Family Health Survey 4 (NFHS 2015-16), out of the 36 states and union territories (UTs), only four--Uttar Pradesh (UP), Bihar, Meghalaya and Nagaland--have a TFR more than or equal to 2.68.

Yet, as many as 12 states have a TFR above 2.1, termed the replacement-level rate, at which the population remains constant.

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