Treatment of Childhood Cancer
With the exception of certain specific treatment steps, children and young people with cancer in Switzerland are all treated at the country's nine specialist paediatric oncology centres. Five of these centres are in the university hospitals in Basel, Bern, Lausanne, Geneva and Zurich, the other four are in St. Gallen, Lucerne, Aarau and Bellinzona. Certain treatments, such as bone marrow transplants or special surgical procedures, are available at just a few centres. In such cases the local team works in partnership with the specialist centre.
Whereas cancer in adults can follow a protracted course, cancer in children generally ends fatally within a matter of months if left untreated. This is because the tumours involved are almost always more aggressive – i.e. faster progressing. The challenge lies in minimizing the long-term side effects of the aggressive treatment in children and young people. An important consideration here is the fact that the medicines used were not developed for children and are administered in what is known as an "off label" context.
Long-term quality of life
Ensuring the scientifically controlled use of these medicines requires clinical studies, primarily treatment optimization studies. In simplified terms, these studies involve adapting treatments that have proven effective in adults to children and adding promising new approaches to existing treatment plans. Such studies are particularly important in paediatric oncology, and they are coordinated and conducted at a nationwide level by the Swiss Paediatric Oncology Group (SPOG), a member organization of Childhood Cancer Switzerland. All Swiss paediatric oncology centres are members of SPOG and can therefore offer treatment in the context of clinical studies. This guarantees maximum quality control and treatment that reflects the very latest findings in paediatric cancer research. Since children develop different cancers from adults and react differently to medicines, they need treatments that are specifically tailored to their needs.
To enable children and young people with cancer to enjoy a good long-term quality of life after successful treatment, reducing late effects is an important part of optimizing treatment options. Because children are still in a state of growth and development, they react particularly sensitively to aggressive treatments. This is why some former childhood cancer patients have major problems with the late effects of their treatment. Examples of such problems include amputation, growth disorders, cardiovascular disease, hormone balance problems, infertility, cognitive difficulties (particularly after brain tumours) or an increased risk of developing cancer again. It can often be decades before serious late effects occur. Former childhood cancer patients therefore need regular examinations to identify such effects at an early stage. This makes aftercare a very important issue. Aftercare, follow-up and the transition to adult medicine are areas where Switzerland needs to make up ground.
Most treatment protocols include a standardized series of post-treatment follow-up examinations. Although these follow-up examinations continue for more than five years after treatment has ended and investigate its long-term effects, they have yet to be harmonized.