Update on National Childhood

Cancer Control Plan

12.3.2020
Marina,Yangon
Malignancies in 2019 at YCH
Benign hematology cases in 2019 at YCH
Workshop 2019: Day 1
Deliverables

Three Proposed Essential Actions for 2019-2021 to help

achieve overall 10 Priority Action Goals for Childhood Cancer
in Myanmar
ACTION 1: DIAGNOSIS
Ensuring Essential Immunohistochemistry, Flow Cytometry, and
Microbiology

ACTION 2: TREATMENT
Ensuring Essential Medicines and Supplies – Chemotherapy,
Antimicrobials, and Other Supportive Care 

ACTION 3: TREATMENT COMPLETION

Supporting Patient Journey and Patient Tracking, starting with
Recognizing Childhood Cancer as a Notifiable Disease, with
Hospital-Based Cancer Registration
 Service delivery

1.Establish ward space 1. Ward space become 75 bedded (2 floors) but same isolation rooms
(4)
with improved isolation Training – 4 Haemato-oncologists, 2 Pathologists, 1 Paediatric radiation
Oncologist
capacity  World Child Cancer (UK)- Training –pathologists, Med Technologists,
2.Implement supportive 
Doctors, Nurses
St Jude Global –Capacity building- Doctors, Nurses, National childhood
care improvement cancer control plan, workshop, regular tumor board online
meeting ,pathology consultation
program  Childhood Cancer International: parents group, Onco-nutrition project
Boston Children Hospital- Nurses training, Extravasation Project, Onco-

3.Establish referral nutrition project
Project
pathway 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.(TGG&NPT)
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 Psychologists
 
 Health workforce
4.Establish curriculum, training, and
practice pathway for community health
providers, specialist physicians, and
nurses
 Curriculum for Basic Health Staff -2nd
edition
 1st Workshop on Satellite Centers – 25
persons for 2days
 2nd Workshop on Satellite Centers –
35 persons for 2days
 3rd Workshop on satellite centers -35
for 2 days
 1st Workshop on Paediatric Palliative
Care – 70 persons for 1day
 2nd workshop on PPC 2 days -25
persons
 3 satellite centers each year for the
education and awareness of BHS and
Pediatricians
 Yearly 6 to 7 post graduate students
doing research
 Currently 3 Doc students doing Thesis
for Leukemias, cytogenetics and
immunophenotyping
 Doctorate program for PHO started
2020
 Health workforce

Training Type Personnel Trained No. Sites of

Completed Trained Implementation of
Facilitation
Overseas Specialty Oncologist/Hematologist 8 Singapore, Malaysia,
Training Experiences UK, Thailand, South
Pathologists 2 Korea, India, US
Nurses 6
Technicians 3
Social Worker 1
International Doctors, Nurses & Data 15 St Jude VIVA Forum,
Conferences Manager Singapore
Doctors & Nurses 6 SIOP
Nurse 1 EBMT conference
On-Site Continuing Paediatricians, Post >100 St Jude Children
Education Lectures Graduate Paediatric Research Hospital,
from International Students, Nurses Guys and Thomas
Visitors (Doctors and Hospital, Singapore
Nurses) (NUH and KKH),
Bangkok, Boston
Children Hospital
 Information systems

5. Establish standard medical  Population Base Cancer

record for childhood cancer Registry by CanReg software
care with hospital- with MOHS
 1 trained data manger with IT
material for Can Reg for Hospital
data entry for all types of cancers
to provide survival rate
 Medical products and techanology
6.Establish sustained access to
essential medicines and to essential
diagnostics and therapies for
childhood cancer
 Submitted essential medicine list
to MOHS included in nationwide
EML
 Essential Medicines list revised
done with City Cancer project for
Paediatric Lymphoma and MOHS
 Financing and governance
7. Increase public financing
coverage of essential
diagnostics and medicines to
80% or higher
8. Establish policies to facilitate
cancer therapy completion
 2016 Dec MOHS(Director General)
meeting with professionals from
childhood cancer care
 e.g., MOHS Budget Allocation for
chemotherapy and supportive care
6monthly( ~70% coverage)
 World Child Cancer funding for
essential medicine monthly (~20% of
nongovernment funding)
 Lin Thant Metta Childhood Cancer
Foundation funding for diagnostic and
medicine monthly (~ 10% of
nongovernment funding)
Family support and community engagement

9. Implement funded  “Golden Hands of Hope” Parent support group led by

housing for families of CCI – regular Monthly meeting,nutrition champions
children undergoing among the parents
cancer treatment  e.g., currently ~ 50 parents with 10 parents in core
group.
10. Support launch of Yearly ICCD International Childhood Cancer Day in

hospital- based Feb, awareness activity, with more than 120
parent/patient participants reached and around 6 medias (Tele,
support groups Journals, Radio all over the country)
 Yearly Cancer Survivors Day around 80 participants
( Media all over the country with interview of parents
and survivor themselves)
 Yearly patients funfair in Dec around 500 patients
with their parents ,broadcasting across the country by
media for child hood cancer awareness
 Workshop Day 1
3 Essential Actions and Sample Immediate Activities

STOP duplicate testing

ACTION 1: START enabling DMR lab to be used for clinical services

DIAGNOSIS By Q2
SCALE-UP capacity building for technicians, pathologists, as well as
equipment and sustainable access to consumables 2020
STOP rotating nurses and other core trained staff (remuneration,
retention)

ACTION 2: START teaching curriculum for postgraduate doctors (to ensure By Q4

evidence-based prescribing / resource use); post-market
TREATMENT surveillance & quality assurance for essential medicines 2020

SCALE-UP consistent procurement (e.g. bone marrow needles x 200

x 2 sites [6 months]) and importation of essential medicines (e.g.
arsenic),BMT room in ICU,BMT training

ACTION 3: STOP treatment abandonment through increased support for

families and providers
TREATMENT By Q4
COMPLETION START recognizing childhood cancer as notifiable disease, 2020
involving all policy makers and community providers
SCALE-UP patient tracking system and training for pediatric cancer
registration and data use
 Myanmar Childhood Cancer Control Programme
Stakeholder Map
May 2016 – Updated May 2019

Number of Stakeholders attending Myanmar National Workshop

in 2016 (N=70)* and 2019 (N=127)*
35
30
25
20
15
10 2016
5 2019
0
i ta
l ic t y S )
nal bal nal
m ie oH
osp
ad
e
So
c
M atio G lo tio
H c il l( N l& r na
l /A C iv on
a a te
ita ti i on In
s p Na Re
g
- Ho
nity
u
m * Additional workshop attendees include childhood cancer
m
Co survivors and their families
 Helping children in Myanmar National
Myanmar
overcome cancer Childhood Cancer
Network
Pyit Tine Htaung
(Burmese Name of Doll Pictured)
To my beloved little girl
I will sing a lovely song of
"Pyit Tine Htaung"
Come and listen to me
Network This will make you happy

Dedicated Pediatric Hematology/Oncology The little Pyit Tine Htaung is short

Units: But he wears so lovely sweet smile
• 300-bedded Mandalay Children Hospital Whenever he is thrown away
• Yangon Children Hospital He can stand again and again
He never falls down
Shared Care Network Sites equipped to
facilitate initial work-up or follow-up for His life and his strong mind
children on treatment closer to home: is so amazing
• North Okkalapa General Hospital (Yangon) He has no hands or legs
• Yankin Children Hospital (Yangon) But he can do everything
• Taunggyi Women and Children Hospital Whenever he has difficulties
He can face these and solve the
Community Network Sites with engaged staff problems with strong mind
familiar with facilitating timely referrals to He never surrender the difficulties
dedicated units / shared care sites: He tries to overcome these
• Bogale • Myingyan A Professional Network to Facilitate
• Hinthada • Naypyitaw Finally he wins everything Communication, Coordination, and
• Magway • Pakokku General Hospital Advocacy to Increase Access and
• Maubin • Pathein My beloved little girl
• •
Strengthen National Delivery of Quality
Mawlamyine General Pyapon "Do you want to compete in running
Hospital • Sittwe race with him?"
Care for Children with Cancer in
• Meikhtile Myanmar under the Auspices of the
• 200-beded Women and Myanmar Pediatric Society within the
Children Hospital Myanmar Medical Association and
(Monywa)
• Myaungmya
Approved by the Ministry of Health and
Sports of Myanmar
T Trifold broacher for the referral network
 Dedicated Pediatric
Hematology/Oncology Units

+Logo of
hospital

Yangon Children Hospital

2 Yeiktha Road
Yangon
Phone:

+Logo of
hospital

A pediatric hematology/oncology unit

has dedicated staff with specialized
training in diagnosing and treating
children with cancer.
300-bedded Network sites have staff with training
Mandalay Children Hospital to identify and facilitate connection to
30th St, Bt 74th & 75th Sts specialty care (for example, initial
Chan Aye Thar Zan Township diagnosis testing or managing fever).
Mandalay Together they provide the best care.
Phone:
Ⓒ 2019
• About 2000 children with cancer are
expected in Myanmar each year
• Childhood cancer is highly curable
with early diagnosis and timely
treatment
• Leaders in Myanmar are working with
the World Health Organization and
partners around the world to improve
Get 60 by 30
Get 60 by 30
2nd NCCCP workshop,multistakeholders
3rd Settlelite workshop and TOT training ,June
2019