The Development of Children's Cancer Treatment in Hong Kong

Prof. Patrick Yuen Man Pan
The Lady Pao Children's Cancer Centre
Department of Paediatrics
The Chinese University of Hong Kong

The tremendous progress Hong Kong made since 1970s in providing medical care to children suffering from cancer and blood disorders has been driven not only by a group of dedicated medical professionals but also by many parents of these young patients. Their efforts supported by the Hong Kong public, the Government, the Hospital Authority, the universities and generous donations from leading business persons in Hong Kong are producing results.

There are now well-trained medical professionals and world-class medical facilities for diagnosis and treatment of cancer and blood disorders in paediatrics. To those involved, it seems amazing that we have been able to achieve so much in less than two decades.

Prior to 1970s, haematology and oncology in paediatrics were largely neglected mainly because paediatricians were discouraged by the poor outcome in children suffering from cancer and blood diseases. Such was the prevailing attitude of the medical professionals when I began my career in paediatric oncology and haematology in Hong Kong on 1st June 1974. On that memorable day in my medical career, I joined the then Medical and Health Department as a medical officer working in the Department of Paediatrics at Queen Mary Hospital, and I never looked back. For that day marks the end of one set of experience and the beginning of another. From that day onwards, I have dedicated the rest of my professional life to the development of paediatric oncology in Hong Kong. Fortunately rapid advances in medical science in paediatric oncology in the early 1970s had helped changed the defeatist attitude that children with cancer were largely incurable. The Department of Paediatrics at the University of Hong Kong was the first institution to play a leading role in the development of paediatric haematology and oncology in Hong Kong in the 1970s. With improved diagnostic facilities and treatment programme, the cure rate for childhood cancer showed a steady improvement. For example, in acute lymphoblastic leukaemia, the most common form of cancer in children, the cure rate rose to 30% in the early 1970s. It has since risen to well over 70% in the 1990s.

In May 1984, I joined the Department of Paediatrics, the Chinese University of Hong Kong. Members of the Department have always shown a keen interest in the treatment of children with cancer and blood diseases. Their efforts have led to the establishment of the Hong Kong Paediatric Bone Marrow Transplant Fund of the Chinese University of Hong Kong in 1988 for the sole purpose of building Hong Kong's first Paediatric BMT Unit. An appeal was made to the Hong Kong public for funding the whole project. The response was overwhelming. In February 1991, doctors in the Department successfully performed the first bone marrow transplant on a paediatric patient in Hong Kong.

Since then, the progress made in the diagnosis and treatment of young cancer patients has gathered pace. In 1989, thanks to the initiative of many parents of these patients, the Children's Cancer Fund of the Chinese University of Hong Kong was founded. In 1991, it was re-named the Children's Cancer Foundation to serve the whole of Hong Kong. The aims of the organization are to promote the physical and psychological well beings of the patients, to strengthen ties between the medical personnel, the patients and their parents, to facilitate mutual support among parents, to promote research and to provide the most up-to-date care for young cancer patients.

With a rapid expansion of service and an increase in patient work load and an improved survival rate, the need for better facilities has become clear not only to the medical profession but also, in more heart-felt ways, to the parents of children with cancer. Led by Mrs. Miami Y W Chow, the Chairperson of the then Children's Cancer Fund of the Chinese University of Hong Kong, its founding members were the driving force behind the development of the Lady Pao Children's Cancer Centre which opened to the public on 29 March 1995. Its opening represents a major step forward in the history of paediatrics in Hong Kong. The Centre is to provide the best available care for children suffering from cancer and blood disorders.

Another important milestone in the development of paediatric haematology and oncology in Hong Kong is the establishment of the Hong Kong Paediatric Haematology & Oncology Study Group in 1993. Its members are doctors and health professionals who are interested in the diagnosis and treatment of children with cancer and blood disorders in Hong Kong. The aims of the Study Group are to gather statistics of childhood cancer and blood diseases, standardize treatment protocols and more importantly, to provide a platform where medical professionals in this field of practice can freely exchange ideas and experience.

My long years of experience in the treatment of children with cancer have given me an understanding of the physical circumstances and the mental outlook of these sick children and their parents and in addition the realization that paediatric oncology is a very laboratory-oriented subspecialty. It requires the support of basic science in immunology, medical genetics, biochemistry and cellular and molecular biology for diagnosis and treatment without which paediatric oncology cannot be practiced to the highest level of excellence. What is required of a paediatric oncologist in the 21st century is that not only he or she should be well versed in basic science and the most-up-to-date diagnosis and treatment of childhood cancer but also sensitivity to the social and emotional needs of these young patients and their parents.

With the coming of the next millennium, one would expect an overall cure rate of approaching 80% in childhood cancer. With such improved survival rate, I would go as far as saying no paediatric cancer centre is complete without a long-term follow-up clinic. We need to study the long-term care and conditions surrounding those young cancer patients and their survival into adulthood. We need also information on the short-term and long-term side effects of their treatment and how successful childhood survivors have been in completing their education, obtaining employment, marrying and raising a family in other words our ultimate aim is for them to become normal healthy adults. This is what the practice of modern paediatric oncology is all about and I must admit is one of the biggest challenges facing paediatric oncologists in the next millennium.

We have come a long way since 1970s. With the existence of so many dedicated and professional staff in the Department of Paediatrics of both the University of Hong Kong and the Chinese University of Hong Kong, and the major hospitals of the Hospital Authority, the future looks bright for paediatric haematology and oncology in Hong Kong. I feel both proud and privileged to have played a role in their development.