Advancing Pediatric Oncology v.1: Insights from Dr. Tezer Kutluk and Dr. Zainab Shinkafi-Bagudu

In this episode of ‘United Against Cancer’, Prof. Tezer Kutluk, a renowned Pediatric Oncologist and Chair of the Turkish Childhood Cancer Registry, speaks with HE Zainab Shinkafi Bagudu. Prof. Kutluk, who is also a past UICC president, discusses the evolving landscape of childhood cancer in Turkey, highlighting a 70% survival rate.

Her Excellency Dr. Zainab Shinkafi-Bagudu is a global cancer advocate, a pediatrician, a UICC Board Member,  Founder of the Medicaid Cancer Foundation (MCF), and the Chairperson of First Ladies Against Cancer (FLAC). Dr Bagudu is working with the state ministries of health, education, and women affairs to implement programs to sustainably improve menstrual hygiene, girl-child education, economic empowerment of women, and put an end to gender-based violence. Zainab Shinkafi-Bagudu is a member of the Editorial Board of OncoDaily.

Tezer Kutluk is a Healthcare Consultant at Kutluk’s Consulting. He is the Past-President of UICC, Union for International Cancer Control. He graduated from Hacettepe University Faculty of Medicine in 1981 as third in his class. He completed his training at Hacettepe University Faculty of Medicine, Department of Child Health and Diseases in 1985. He became a pediatric oncology specialist in 1992. Previously he has worked at the University of Texas MD Anderson Cancer Center in Houston.

Zainab Shinkafi-Bagudu: Professor Dr. Tezer Kutluk, a pediatrician who completed his specialist training and became a pediatric oncologist, has held various academic and administrative roles in Turkey and other prestigious institutions, amongst which he worked in cancer research at the University of Texas MD Anderson Cancer Center as a Fulbright Scholar and later on as a member of the staff. Amongst some of their key positions include being the Deputy Chief Physician of the University Children’s Hospital in Turkey.

He was a member of the Board of the International Children’s Center, President of the European Cancer League, President of the Turkish Pediatric Oncology Group Association, and indeed he was a past president of the Union for International Cancer Control. During his tenure, he famously addressed the United Nations General Assembly opening session and is very keen about pediatric oncology and childhood cancers. So thank you very much, Doctor, for joining us today, and we’ll go straight into it, considering your busy schedule.

As you know, my name is Zainab Shinkafi-Bagudu. I’m a pediatrician like yourself, but much younger and less specialized in oncology. I am more of an advocate, and so we’re doing this interview to see how we can link the work that you’re doing and promote it globally, amplify it while showing the interaction and the commitments to interact between stakeholders in the space.

So thank you. My first question to you today would be to ask you if you can describe some of the unique challenges that you face in diagnosing and treating childhood cancers in Turkey. First of all, give us a background of Turkey in terms of the economic brackets.

We know that one of the greatest challenges that we have in pediatric oncology, we’ll go straight to the points now, is the wide disparity between high and low middle income countries in diagnosis and in outcomes. So for yourself in your area of practice, having been in a Western high income country and now practicing in Ankara, please give us a brief overview of that.

Tezer Kutluk: First of all, I’d like to thank you and the organizers for the kind invitation. It’s going to be a pleasure for me to talk about the situation in Turkey, what we are doing, how we are doing. Turkey, as you mentioned, is an upper middle income country with a population of 85 million.

So we have a population of children younger than 14 years of age is about 20 million. So every year we expect to see 3,500 new cancer patients. That’s not a big number when you compare this number with the adult cancer patients.

So every year Turkey expects 240,000 adult cancer patients. So compare 240,000 with 3,500. So that makes your life difficult because it’s a small number.

It’s all over the world. We are facing the same issue. How can we raise the childhood cancer as a priority issue in the health market?

In Turkey, actually, I can say we are doing good in many sides because pediatric oncology became a sub-specialty in 1983. If you go back, we see the roots of the pediatric oncology in early 70s. So for the last 30, 40 years, Turkey is investing a lot on the pediatric oncology.

When I started my pediatric oncology career in the mid-1980s, so those were the days, the pediatric oncology centers mostly were located in major cities. But now we see more pediatric oncology centers distributed all around the country. But here is the problem.

Number one is the government sent pediatric oncologists and hematologists in the peripheral part of the country. But in those places, we don’t have a comprehensive team. So still people keep coming to major cities.

But at the end, how are we doing access to care, access to medicine, access to diagnosis, access to surgery, and others? We are doing well in many sides. The outcome for the childhood cancer is I am running the Turkish Pediatric Cancer Registry.

We were able to reach at least two-thirds of the cases results. So I would say the long-term survival, five-year survival rates at the moment in Turkish children with cancer is about 70%, which is an acceptable level for an upper-middle-income country. This is where we are supposed to be.

So in this aspect, okay, we don’t have a major problem on access to medicine, access to care. I will tell you later what kind of problems we have.

Zainab Shinkafi-Bagudu: Okay, you are answering all the questions.

Tezer Kutluk: Thank you. Of course, but what Turkey did during the last 10 years, Turkish government put the universal health coverage in practice. The law became effective in 2012.

So every Turkish children has access to care. However, what are the problems? One main problem, I think not only in Turkey, in many parts of the world, when I started pediatrics, I was in the third rank on the graduation in one of the best medical school in Turkey.

I was so motivated to be a pediatrician. Nowadays in Turkey, pediatrics is in the last order of the choices. So nobody wants to be a pediatrician.

Among those who prefer to pediatrician, when they finish pediatrics, they don’t want to become a pediatric oncologist. So not at the moment, but in the near future, we will have a human resource problem finding the pediatric oncologist. Of course, in major cities, you will see all sub-specialties, surgeons, nurses, pathologists, but in the peripheral part, not complete comprehensive care of the cancer patients.

They still keep coming to Istanbul, Ankara, and big cities. This is one of the issues we have to invest more. Human resource is another thing we have to invest more.

But I will also mention the landscape in oncology is changing, not only for children, but also adults. New diagnostic modalities, new treatments, targeted medicine. How are we doing access to targeted therapies?

In some ways, we are not that bad. We are able to access to many of the targeted therapies, but still going a little bit slower. For example, as an example, dinituximab, a targeted medicine for the care of neuroblastoma patients, came to Turkey two years later than Europe.

Two years is acceptable, of course, but still we have a problem. What I would say is we have some limitations on the research. Maybe we can discuss later how we are doing the pediatric cancer research.

Our adult colleagues are doing a lot of clinical trials, but we are having difficulties on performing or conducting clinical trials in children. Although I was able to lead two international clinical trials in my department, still research and clinical trials is an area we can invest more because we have the capacity, the population. We have enough human resources, but still we have some problems.

These are basically what I will say about the landscape.

Zainab Shinkafi-Bagudu: Thank you so much.