Despite a National Service Framework for children, which sets standards, there are no targets, and children continue to be a low priority for the NHS.
According to Alan Craft (Institute of Child Health, Newcastle Upon Tyne, UK) and Kathy Pritchard-Jones (Royal Marsden Hospital and Institute of Cancer Research, Surrey, UK), routine surveillance and the primary care of children need to be rigorously assessed, while politicians need to take the health of children seriously and make an appropriate level of investment, to ensure that the UK improves by comparison with the best-performing countries in Europe.
The authors highlight that in Germany, trials on Wilm’s tumour—a common solid tumour of childhood— showed that between 1994 and 2001, 27.4% of patients had a cancer that was first identified during a visit to a health professional for an unrelated problem or by routine surveillance. In comparison, in the UK, just 11% of patients presenting to the Royal Marsden Hospital in London, and 4% of patients referred to the Newcastle Hospital or the Royal Victoria Infirmary in Newcastle were identified. In Germany, early diagnosis by routine or incidental examination was linked to increased survival.
The authors suggest a number of possible reasons for the considerable variation in childhood cancer survival in the UK. They believe that children in the UK have been receiving a different treatment protocol than their European counterparts possibly involving suboptimum first-line treatment or less-intensive salvage treatment at relapse, because until recently there was no European-wide standard clinical protocol. Furthermore, routine health-surveillance systems and opportunities for diagnosis for children differ considerably across Europe. In Germany, most children have their own primary-care paediatrician who undertakes regular health checks, whereas in the UK, according to the authors, the Health for all Children guidelines are not as thorough, with few routine examinations being recommended.
The authors conclude, “Suboptimum survival for childhood cancer is just one example of the worse state of children’s health care in the UK compared with many other countries. The perinatal mortality rate puts the UK in 15th position in Europe and there is clear evidence that children with diabetes are [also] not receiving optimum care”.
Tony Kirby | alfa
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