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On the Need for Nonmedical Pediatric Oncology Services in India
10 October 2025
Sandhya Sharad - Founder, Samiksha Foundation - Caring for Children with cancer
Lavanya Manickam - Vassar College
As of 2021, approximately 400,000 children from 0-19 years of age develop cancer each year. In low and middle-income countries, less than 30% of children with cancer are cured, compared to the 80% of children who live in high-income countries, where more extensive services are easily accessible.1 Studies have shown that this success can occur in less-resourced countries as well with the implementation of similar programs and shared expertise.2 In India, pediatric cancers (cancers affecting children 0-14 years of age) comprise 4.0% of all cancers, as of 2022.3 A 2016 review found that that the most common childhood cancer in the country — leukemia — had a national overall survival rate ranging from 45% to 81%, while a survey from the same year estimated the survival rate for all pediatric cancers in India to be 63%.4 5
India has been making progress concerning the cancer problem by implementing the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) — however, a specific national policy addressing childhood cancer still does not exist. A 2023 study assessing India’s pediatric cancer care services established that while available care is mostly found at the tertiary level of healthcare services, there is a gap in the availability of specialized pediatric oncology services. For example, there lacks a pediatric oncology department in more than half of public and private tertiary-level hospitals, and less than half of public tertiary hospitals have stocks of the core four cancer-treating drugs, nor contain essential physical infrastructure. While most tertiary hospitals do have supportive care facilities for children with cancer, they still predominantly do not have the facilities for play therapy and hospice care.6
Cancer is a gruesome disease, not only causing merciless effects on a patient’s body, but on their mind as well. Cancer and the treatment it necessitates have an extreme impact on a child’s well-being, with a Hong Kong study finding that many pediatric cancer patients exhibit high anxiety levels on admission into the hospital, and more than half present depressive symptoms during their stay.7 Healthcare centers, therefore, need to take appropriate measures to ease this psychological burden of having a life-threatening condition at such a young age.
In India, there are many descriptive studies and documentation on cancer’s influence on anxiety and emotional distress in adults. However, there is scarcely any interventional-type research done on the psychosocial effects of cancer, especially on children. Of the few studies completed, it was found that various techniques of psychological intervention resulted in positive effects on the social-emotional functioning of childhood cancer patients. For instance, physical activity and yoga managed cognitive fatigue and sleep, and music, reading, and art therapy reduced procedure-related anxiety and increased well-being and resilience.8 Play and education are important aspects of psychotherapy, and are thus crucial to treating pediatric cancer patients. Play is a fundamental part of childhood that allows an individual to become socialized, properly communicate, and learn self-expression and imagination. Play therapy, therefore, gives children the opportunity to engage in these practices while being hospitalized, managing their anxieties and fears within the enclosed environment of a cancer center.
Additionally, the educational needs of children with chronic illnesses are largely ignored by their schools while they are hospitalized. Bringing school to pediatric cancer patients when they cannot attend physically is imperative, not only for the children’s self-esteem, but to ensure that they do not fall behind their peers academically — an outcome affecting grade repetition and later, employment. In most high-income countries, educational programs within hospitals have existed successfully, providing primary school to college levels of learning.9 In Australia, for example, a children’s hospital has developed a hospital-based schooling intervention named the Oncology Education Program, and found that parents both valued the service and were satisfied with how their child adjusted to regular schooling upon returning.10 In the Indian healthcare system, there is an extensive lack and ensuing need for similar interventions in pediatric cancer care. There is also an urgent need for the recognition of the Gap in Education of such children.
The Samiksha Foundation is one of the few intervention programs that exist nationally, implementing both play therapy and educational support to oncology children in South India. Founded in 2008, the nonprofit’s mission is to provide non-medical support to children undergoing cancer treatment, increasing their emotional well-being through learning and creative activity. The organization operates within six hospitals in Bengaluru, integrating individualized educational services with creative expression, yoga, and play for each child. Through the use of a digital learning platform, Samiksha is able to provide remote learning assistance to students unable to be physically present. Post-treatment, the program funds scholarships for Samiksha students, supporting young survivors' progress into higher education. This report discusses the projects completed by the foundation, and the impact of their non-pharmacological services on children with cancer.
Samiksha Foundation - Caring for Children with cancer - Summary
Samiksha Foundation’s non-medical holistic support model is based on three core pillars: educational support, emotional and spiritual well-being, and creative engagement and play. Trained teachers and volunteers provide in-person academic support for hospitalized children, and their Digital Education Program allows for one-on-one tutoring virtually. While Samiksha’s work is tailored to teaching adolescents between the ages 4 and 18, their programs extend to supporting their families as well, 75% of whom are from low socioeconomic backgrounds. These programs include multilingual library access; yoga, meditation, and creative therapy integrated into the children’s and caregivers' routines; storytelling and craft sessions; and “Milestone Celebrations” for birthdays and treatment achievements.11
From 2009 to 2025, the Samiksha Foundation has served 15,706 students, working with 1200 new children each year across learning centers. The Digital Education Program is currently expanding to reach 500 more children remotely, to foster continuous learning during home stays or after treatment. In pursuit of their mission to support their students' higher education, the Samiksha Foundation Scholarship Program has awarded 527 scholarships and distributed over INR 78 lakhs directly to students over the last seven years. Currently, over 35 alumni are pursuing professional courses such as Medicine, Hospitality, and B.Tech. Eleven alumni are employed in leading MNC firms or commercial establishments, and at least two are paramedical technicians.
While the quantitative output of Samiksha’s programs reveals the positive impact of the learning initiative on students undergoing cancer treatment, there are multiple qualitative accounts of Samiksha’s effect as well. The foundation employs a multidimensional approach to care, facilitating a therapeutic alliance between medical assistants, parents/caregivers, and children that they name “The Triangle of Care.” Over the course of its sixteen years, Samiksha has gathered several accounts from these three groups that show the impact of their holistic approach to healing. For instance, in 2025, both the Indira Gandhi Institute of Child Health (IGICH) and the Sri Shankara Cancer Foundation issued statements of support for the Samiksha Foundation. Dr. Pooja Gujjal Chebbi, Professor of Pediatrics & Pediatrics Hemato-Oncologist at the IGICH stated that Samiksha create a “child-centric ecosystem of care,” that has led to “improved treatment adherence and psychological resilience; reduced fear and anxiety related to hospitalization; continuity in learning and reintegration into formal education; and a more positive and hopeful hospital experience for children and families."12 Dr. B.S. Srinath, a surgical oncologist and managing trustee of the Sri Shankara Cancer Foundation, wrote that Samiksha provides “structured sessions through personal attention to each child,” that benefited the “siblings and parents of patients” as well.
Ms. Vidyavathi B.S., the first teacher at Samiksha Foundation, who remains the Center Coordinator at Sri Shankara today, has written a testimonial detailing these structured sessions. She writes that the teachers come into the center three days a week — conducting regular academic sessions on two days and hosting yoga, drawing, and storytelling sessions on the other day. In Ms. Vidyavathi’s testimonial, she shared a story about a student named Jayani, who “used to sit silently when she first joined” Samiksha, but began to engage in reading and writing when exposed to the communal learning environment. Jayani began to look forward to hospital visits because of the school. Ms. Vidyavathi writes about Jayani, " If Samiksha teachers are not visible when she arrives, she takes her father’s phone and calls us saying, ‘Why haven’t you come yet? I’m still waiting — please come soon!'”
Samiksha Foundation has documented several accounts from students over the years “Survivor Stories” from children who have completed cancer treatment while attending Samiksha school at hospital and after. Many of these stories are from children who were admitted to Kidwai Memorial Institute of Oncology and treated by Dr. L. Appaji, the Head of Pediatric Oncology at the time. Dr. Appaji’s research includes epidemiological, clinical, and molecular studies of pediatric cancers, and has published findings on the effect of play therapy in pediatric oncology. In 2012, he worked with two psychologists on a PhD study in which they examined the effects of psychological intervention on adolescents hospitalized for Acute Lymphoblastic Leukemia. The intervention consisted of 20 sessions of non-directive play therapy with a young girl called “Seema.” Seema initially portrayed inhibited behavior, engaging only in “rudimentary play” and avoiding medical toys, yet, as sessions continued, her play became similar to that of healthy children. A staff nurse reported Seema’s increased cooperation for medical procedures, and a better mood overall. The study concluded that if oncology medical teams provide the opportunity for play therapy, and the necessary space for flexibility in therapeutic practices, then these interventions can facilitate “better adjustment to illness related stressors” for hospitalized children.13
The Samiksha Foundation’s project of creating an outlet for play in pediatric cancer wards yielded these similar benefits exhibited in Dr. Appaji’s study, as demonstrated by the collected “Survivor Stories.” Two children, Abhishek and Renuka, both stated in their testimonies that the activities provided by the school, such as storytelling and yoga, made them “hardly feel” or “forget” that they were in a hospital. Another student graduated from Samiksha, Gagan, writes, “What I would like to tell others is that do not be afraid, follow all that the doctor tells you to do. At that time Samiksha Foundation came as a great help – I used to draw, read many books, played games, and watched magic shows. Because I was doing so many things, I never got the feeling that I was in a Hospital.” Many children proclaimed the desire to continue schooling due to their Samiksha education during cancer treatment, and their financial ability to do so because of Samiksha scholarship. Many survivors are pursuing teaching, engineering, commerce, and more. “Few hospitals are like this,” writes a student named Lavanya. “When we are at home for a day, we would be crying about going to school the next day — but we went for 9 months to Samiksha school and on our return we were still eager to go to the next class.” In short, Samiksha schooling facilitates an easier transition into the extended hospitalization that pediatric cancer patients experience, while also allowing for a smoother transition out of the ward, by ensuring that students are not left behind academically.
Conclusion
As Dr. Appaji’s study notes, “Play is considered a “lifeline” for children with cancer; a means through which they express and make sense of their distress, develop coping resources, and implement coping strategies."14 There is currently a gap in India’s pediatric oncology services, in which this lifeline is not made steadily available across both public and private tertiary-level hospitals. Samiksha plugs in fragments of this gap, operating within several hospitals across Karnataka, yet cannot serve on its own — this type of schooling must work in tandem with a system that values building the infrastructure for these psycho-social interventions. Non-medical services such as play therapy and educational services are necessary outlets that facilitate the success of traditional therapeutic treatment. Creating structural support for nonmedical interventional programs such as at Samiksha is the necessary next step in this holistic support for pediatric cancer.