Post on 03-Jul-2020
Pediatric Palliative care in Childhood Cancer (Myanmar)
Aye Aye Khaing Yangon Children Hospital
NayPyiTaw, Mingalar Thiri 26.11.19
M
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Myanmar is the second largest country in Southeast Asia with an estimated total population 59.13 million,U5 MR 52
2 PHO Centers 6 Paediatric hemato-oncologists
Anticipated new childhood malignancy cases 1800 to 2500 per year
Aye Aye Khaing Professor MBBS,MMed Sc(Paed),MRCPCH, Dr Med (Pead) Paediatric Hemato Oncology Unit Vice-President –Myanmar Society of Haematology
Haemato-oncology in Yangon Children Hospital, Myanmar
Sossolid
Y
58.8% 21.4%
41.6%
25.9% 25.0%
58.8%
50.0%
62.5%
33.3%
1 year Overall Survival Rate
Yangon Children Hospital Hemato –Onco Unit
Level of Supportive Care: SIOP PODC
1.Hand washing or disinfectant facilities 2. Implement nutritional assessment and nutritional support 3. Availability of oral morphine and use WHO pain ladder 4. Invest in providing social support (travel money, free board and
lodging) 5. Risk of extravasation of chemotherapy 6. a local management plan for febrile neutropenia 7. Avoid mucositis by not using toxic regimens 8. Children with HIV/AIDS and cancer can be treated like other patients
(EO) 9. Chemotherapy should not be delayed in children with TB (EO) 10. Anti-emetics (no lorazepan ) 11. Painful procedures :a separate room : proper medication 12. Blood transfusion guidelines must be adapted to local conditions
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• 25.11.19 YCH in patients-54 • Patients on active management -34 • Patients on palliative chemo-13 (38%) • Patients on morphine -6 (18%)
Current needs for the palliative care
Workshop Day 1 – Yangon Summit Parkview Hotel, May 5, 2016
Workshop Day 2 – Naypyitaw Horizon Hotel, May 6, 2016
National Workshop on Childhood Cancer Control Programme in Myanmar 2016
2nd NCCCP workshop, multistakeholders May 2019
Service delivery
1.Establish ward space with improved isolation capacity 2.Implement supportive care improvement program 3.Establish referral pathway
1. Ward space become 75 bedded (2 floors) but same isolation rooms (4)
2&3. Training – 4 Haemato-oncologists, 2 Pathologists, 1 Paediatric radiation Oncologist
• World Child Cancer (UK)- Training –pathologists, Med Technologists, Doctors, Nurses
• St Jude Global –Capacity building- Doctors, Nurses, National childhood cancer control plan, workshop, regular tumor board online meeting
• Childhood Cancer International: parents group, Onco-nutrition project
• Boston Children Hospital- Nurses training, Extravasation Project, Onco-nutrition project
Project o Onco-Nutrition project by a nutritionist (BCH and CCI) covered
60% of new patients. o Early Recognition of Childhood Cancer campaign – two
workshops every year at satellite centers. o Paediatric Palliative Care (PPC)
o Satellite Training Workshop for Pediatricians and nurses from networking centers (11 State and Divisional Hospitals)
• Other Activities(Psychosocial support) o Heroes School o Psycho Counselling by Clinical Psychologist
1st workshop 2017
2nd workshop June2018
3rd workshop Nov2019
2018 WHO childhood cancer initiative
• cancer is the leading cause of death for children, with 300,000 new cases diagnosed each year among children aged 0-19 years.
• Children with cancer in LMICs 4 times more likely to die and accounts for 80% of the target population.
• Increase 2 folds prioritization of childhood cancer • Double the cure rate of childhood cancer and • No more pain/ suffering of childhood cancer by
2030
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• ensure the right • to early and proper diagnosis • to access life-saving essential medicines • to appropriate and quality medical
treatments • to treatment without pain and suffering
and when a cure is not attainable • the right of the child to a pain-free death.
No more pain :ICCD 2019
The WHO pain ladder
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www.paineurope.com
Since 2018
The WHO pain ladder The WHO pain ladder is a framework for providing symptomatic pain relief. The three-step approach is inexpensive and 70–90% effective
By mouth The oral route is preferred for all steps of the pain ladder
By the clock Cancer pain is continuous - analgesics should be given at regular intervals (every three to six hours), not on demand
Adjuvants To help calm fears and anxiety, adjuvant drugs may be added at any step of the ladder
16
d
Less suffering
s
suffering
Aug 2012 2014 2015 2016 2013
Myanmar Training-of-Trainers Program
In-country teaching modules
• 7 volunteer faculty
• 28 trainees
F 1 F 2 F 3 F 4 F 5 F 6
National Opioid Seminar
New service Starts at YGH
Study visit
Clinical attachments
2017 2018
2019 2020 2021 2018
Myanmar Training-of-Trainers Program
Needs assessment PPC workshop
• 25 trainees
F 2 F 3 F 4 F 4 F 5 F 6
PPC training At St Jude 1 month Padiatric oncologist
PPC Workshop KKH Singapore 1
PPC training At St Jude 10 days 2 nurses
35 trainees,8 displines Oncologist Othopedic Renal Cardiac Neuro,ICU,Neonate