Choosing where to treat your child — what to look for in a paediatric cancer centre

A tumour board is a structured meeting in which medical oncologists, surgical oncologists, radiation oncologists, radiologists, and pathologists review each patient’s case together and agree on a unified treatment plan. This is the single most important feature of a capable paediatric cancer centre. Childhood cancers are complex, and no single doctor — however experienced — has the full range of expertise that each case demands. Hospitals that routinely run tumour boards make fewer diagnostic errors, choose more appropriate protocols, and avoid unnecessary treatment. Before committing to any centre, ask: “Does a tumour board review every new paediatric case? How frequently does it meet? Will my child’s case be presented before treatment begins?” A confident “yes” with a specific meeting schedule is what you want to hear.

At CION: Every patient is presented to the multidisciplinary tumour board before any treatment plan is finalised — medical, surgical, and radiation oncologists together, reviewing reports and imaging and agreeing on the approach jointly.

Paediatric oncology covers a wide range of cancer types — from leukaemias and lymphomas to brain tumours, bone sarcomas, Wilms tumour, neuroblastoma, and more. A centre that frequently treats blood cancers in children may have much less experience with rare solid tumours or central nervous system tumours. Volume matters: a team that has seen many cases of a specific tumour type has better-practised decision-making, is more likely to recognise atypical presentations, and is less likely to make staging or biopsy errors that are very difficult to correct later in treatment. Ask the oncologist directly: “How many children with this diagnosis have you treated in the last two years? What protocol does your centre follow for this cancer type, and is it based on an established national or international paediatric guideline?” You should receive a specific, confident answer to both questions.

The biopsy is the most consequential step in the entire diagnostic process. Everything — the tumour type, the grade, the molecular subtype, the treatment protocol, and even the surgical plan — flows from what the pathologist reports when they examine the biopsy tissue under a microscope. A pathologist without specific paediatric oncology experience may misclassify a tumour, miss a rare variant, or fail to order the molecular tests that are now standard for certain childhood cancers. Ask the centre where biopsy specimens are sent for analysis, whether the reviewing pathologist has paediatric oncology expertise, and how long it takes to receive the full report including any molecular tests. Some molecular tests require the specimen to be sent to specialist reference laboratories, which can add days — ask whether this is the norm at this centre and what happens to the treatment timeline while awaiting results.

Children are not small adults when it comes to cancer treatment. Treatment protocols for childhood cancers are specifically designed for developing bodies — the dosing, the scheduling of treatment cycles, the supportive medications, and the monitoring of organ function during treatment all differ from what an adult with the same type of cancer would receive. A centre accustomed to treating adults using adult oncology protocols should not apply those same parameters to a child without paediatric-specific expertise. Ask whether the treating oncologist has specific training or experience in paediatric oncology, and whether the chemotherapy dosing and supportive care plans follow a recognised paediatric protocol. For families in Telangana and Andhra Pradesh, also ask whether the team has experience navigating the financial and logistical support programmes available through Aarogyasri or CGHS for paediatric cancer cases.

Treating the tumour is one part of caring for a child with cancer. The rest of the child — and the rest of the family — needs support that purely medical treatment cannot provide. A capable paediatric cancer centre has access to professionals beyond the core oncology team: a psycho-oncologist or child psychologist who can help the child (and parents and siblings) cope with the emotional weight of diagnosis and treatment; a paediatric nutritionist who can support the child’s nutritional status through chemotherapy and surgery; and a social worker or patient counsellor who can help the family navigate insurance claims, financial assistance schemes, school arrangements, travel logistics, and accommodation. If a centre has no allied care team or makes the process of accessing these professionals difficult, the burden on the family throughout treatment will be significantly higher. Ask specifically: “Who do I contact if my child is struggling emotionally during treatment? Is there a nutritionist who works with children?”

The financial cost of childhood cancer treatment can be substantial and prolonged, and families who are not given a clear cost estimate upfront can face compounding financial crises during what is already the most stressful period of their lives. A responsible paediatric cancer centre will provide a written, line-by-line estimate that covers consultations, all planned cycles of treatment, surgery (if planned), imaging, supportive medications, and anticipated hospitalisation. Ask separately about costs that may not appear in the initial plan: additional scan rounds at restaging, blood transfusions, platelet support, intensive care if required. A centre that can only give a vague verbal range — or that is reluctant to discuss costs at all before treatment — is one where financial surprises are more likely. Also ask whether a financial counsellor or social worker can help you explore Aarogyasri, CGHS, ECHS, ESI, insurance cashless, or charitable foundation support.

A confident, responsible paediatric oncology centre will encourage you to seek a second opinion on both the pathology and the treatment plan — and will make it straightforward to do so by providing copies of all reports, scan images, and biopsy materials without delay. If a hospital is reluctant or discourages second opinions, take that as a concern. Equally important: a centre that operates with integrity will tell you honestly if a situation arises that is beyond their current experience or resources, and will facilitate referral to a more specialised centre rather than attempting to manage a case they are not equipped to handle well. This kind of honesty is rare and valuable. Ask directly: “If a complication arises that you have not seen before, what is your protocol? Do you have a referral relationship with higher-level paediatric centres?”