A Science and an Art – Treating Children with Cancer (9 min read)

Every time pediatric oncologist Dr. Mae Dolendo has to tell parents that their child has cancer, she makes a promise – one she has never broken. She promises the family that she and her team at the South Philippines Medical Centre in Davao City will do their best. Of course, most doctors would offer those words. But for Philippine children with cancer, she is perhaps their greatest hope. Too few treatment centers exist on her island of Mindanao. She has made it her life’s work to change that.

Cancer treatment is both a science and an art, explains “Doc Mae,” as her patients call her. The science part includes diagnosis, treatment methods, and patient management. But the real art of oncology is caring for patients and connecting with people, because cancer treatment requires a long-term relationship between patient and physician. “Your patients stay with you for years. You care not only for the kid, but also for the family that brings their child to you. It's a relationship and a journey that is not common in other medical disciplines.”

You care not only for the kid, but also for the family that brings their child to you.

Island Logistics

Dolendo’s promise includes creating oncology therapy where there is none, and bringing care closer to patients. Seeking specialist medicine usually means a long journey. The country has over 7,100 islands, with a combined population of more than 100 million¹. Manila, the nation’s capital, sits on the largest island, Luzon. Mindanao is the second largest island, bigger in size than Austria,² and home to nearly three times as many people, about 25 million³. Yet the terrain of the island country presents a logistics nightmare for families of children with cancer. There are only about 40 pediatric oncologists in the entire country, many of them in or near the capital⁴.

Doc Mae says 80 percent of her patients come from across Mindanao and neighboring islands. She recalls one child with widely spread tumors throughout his body and lungs. He was in great pain and had to be carried in a hammock. To get to the mainland from their island, the family had to cross the sea, then travel by bus by for several hours to Davao. “If you are well, you find the journey tiring,” says Doc Mae. “For a child who is sick, in pain and bleeding, it is a lot of suffering.”
 

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Such cases illustrate why the islands need satellite clinics that can offer therapy closer to the patient’s home, says Dolendo. ”This patient was already in late-stage disease, and when the child wanted to go home, we found a nearer satellite that could offer palliative care.” World Child Cancer, a UK-based charity that works to improve the lives of children with cancer in low and middle income countries, supports Dolendo’s program. Sandoz provides financial support for training local staff . The Sandoz Philippines organization is also engaged locally with World Child Cancer and supporting Doc Mae.  For example, an associate awareness event resulted in additional donations to World Child Cancer, benefitting Doc Mae’s work to establish satellite medical centers in rural areas.

“The healthcare system encourages people to come to big cities, meaning the number of specialists in the more remote regions is incredibly low,” said Kuntal Baveja, Country Head and President, Sandoz Philippines. “Our goal is to make sure more and more people do not needlessly suffer, and it is initiatives like this that will make a difference, bringing together awareness and the know-how, and having a clear, beneficial impact in the end. I am very proud of our collaboration with World Child Cancer.”

Some satellite clinics also offer “House of Hope,” temporary homes for parents and children on outpatient treatment, providing activities and even schooling for patients who are on long-term treatment. Satellites also offer Child Cancer Awareness and Education campaigns, because a child’s chances of survival are much higher when cancer is diagnosed early.

A Caring Career

Dolendo's own journey to pediatric oncology began at a young age. “Ever since I was nine, I told everybody I wanted to be a doctor – and I always keep my promises!” she laughs. But tragically, when she was 17, her mother died of breast cancer. As painful as the experience was, Dolendo believes it has made her a better doctor. She can empathize with patients and families. Palliative care, pain therapy, is more meaningful: “I saw my mother suffer and I don’t want that to happen to my patients.”

After training in pediatrics, she relocated to Singapore with her family, where she specialized in pediatric oncology. Yet she was determined to return to Mindanao in the Philippines. At that time, she says, conditions were heartbreaking. Because children with cancer were often put in hospital beds next to patients with diarrhea or pneumonia, many died of infection rather than cancer. She found it very frustrating, she says, because in Singapore she had seen kids beat cancer, and knew it was highly curable.
 

Carmen, seven years old, was diagnosed with leukaemia. Carmen stays at the House of Hope in Tagum, Philippines, with her mother, but her father remains in Luzon, where he works in construction. She is part way through her treatment for leukaemia and often feels lonely in the hospital. Salvadore, six years old, and his mother travel for three hours by bus to reach Davao Regional Hospital. He has been receiving treatment for leukaemia since 2015, and is now in the maintenance phase, so he attends the center every three weeks.

The oncology ward at Southern Philippines Medical Center, Davao City, is decorated with colorful balloons. Children undergo cancer treatment for years, and build special relationships with Dr. Dolendo, pictured here as she attends to a young patient.

On the left, the House of Hope (HoH) Southern Philippines Medical Center, Davao City, offersa classroom and 10 rooms for patients and two caregivers. Without this, some patients abandon treatment for lack of a place to stay. But HoH offers much more than a bed. Activities and celebrations are regularly held in the shared area. Family members also maintain the facility.

Childhood survival rates in the Philippines have greatly increased, thanks to the work of pediatric oncologists and specialized care. Young cancer patients at Southern Philippines Medical Center, Southern Philippines, Davao City.

There are both good and bad things about her profession, summarizes Dr. Mae. “I went into medicine because I love talking to and caring for people, and I love children.” Losing them is horrible, she continues, but there are more plusses than minuses. “You create memories with the children, and you save lives. I like the humanity that goes along with the science.”

I’m happy that my life's work has yielded better circumstances for marginalized children with cancer.

Hope and Hurdles

Even in the hardest of times, or when clinic staff run out of medicines for their patients, they never run out of love for them, Dr. Mae told members of the United Kingdom’s House of Lords in late October, where she and member of World Child Cancer had been invited to speak. Her words add human emotion to the statistics.

Dolendo said that as disheartening as cancer diagnosis may be, it is the first step toward treating the disease. Many families do not know much about cancer, nor recognize its signs. Through the work of World Child Cancer, dozens of young patients from across Mindanao are alive today, about half of those diagnosed with cancer, she added up from roughly 10 percent a few years ago.

Nurses and oncologists from Cameroon and Ghana, also present at the House of Lords event, said getting medicines and educating families are big hurdles in their countries, too. Their patients also must travel long distances for oncology care, and often have no place to stay. But the efforts by World Child Cancer are showing results. Lorna Renner, Head of the Paediatric Oncology Unit in Accra, Ghana, says the program’s success helped her to convince her country’s government to fund all cancer treatment for children.⁵
 

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Dr. Mae Dolendo enjoys time with patient Alyssa. At age five, Alyssa was diagnosed with Wilms’ tumour (cancer of the kidney). One kidney was removed, and she received chemotherapy at the Southern Philippines Medical Center. She had a difficult time, but recovered well and is now nine years old.

Beating Cancer

Most of the world’s children live in developing nations, where cancer care is still in its infancy. The Philippines has a very young population, Dolendo points out, with about 35 million children ages 14 and under⁶. About 3,500 new cases of childhood cancer are diagnosed per year⁷, 1,000 of those in Mindanao. She hopes that her pediatric oncology efforts, supported by World Child Cancer, can serve as a model, in the Philippines and among other Asian countries. This will give more children in the even larger populations in Indonesia, China and India the chance to beat cancer. “If you achieve 40 or 50 percent improvement in survival rates in Asia, just imagine how many children you're going to be saving!”

Most of Dolendo’s patients come from very poor families, who often cannot even feed their children, or send them to school. Being able to treat cancer among these families is just short of a miracle, she says. “I'm happy that my life's work has yielded better circumstances for marginalized children with cancer.”

During her medical studies in Singapore, the “amazing” pediatric oncology team at the university hospital inspired Dolendo. “They were really good at both science of medicine, and at the art of taking care of and caring for children. I wanted to be just like them.” And, has she succeeded? With a buoyant laugh, Doc Mae exclaims, “Yes! I have become the kind of doctor I wanted to be.”

1. https://www.cia.gov/library/publications/the-world-factbook/geos/rp.html
2. Mindanao Island, ca. 100,000 sq. km; Austria 84,000 sq. km http://www.nationsencyclopedia.com/
3. https://psa.gov.ph/content/mindanao-comprised-about-24-percent-philippines-total-population
4. http://www.cancercontrol.info/cc2015/the-global-improvement-of-childhood-cancer-care-in-the-philippines/
5. email write up 11.11.16 World Child Cancer at the House of Lords / Amanda Stuart
6. https://psa.gov.ph/sites/default/files/2013 PY_Demography.pdf
7. http://www.cancercontrol.info/cc2015/the-global-improvement-of-childhood-cancer-care-in-the-philippines/; World Child Cancer

Lead image: In the Southern Philippines Medical Center, Dr. Mae Dolendo looks at a book with her patient, Alyssa, and the girl’s mother. Credit: World Child Cancer