Yuna (pseudonym), who is fighting pediatric cancer, and her family saw their lives change dramatically last September. That was when the Pediatric Hematology and Oncology Clinic opened at Kangwon National University Hospital (KNUH).

Until then, Gangwon Province had no pediatric hematology and oncology specialists to treat childhood cancer patients. Like other pediatric cancer patients, Yuna's family had to travel to a university hospital in Seoul for treatment. Yuna's parents, who both work full-time, had no choice but to go to Seoul every week for treatment. However, since starting treatment at Kangwon National University Hospital, they have been able to reduce their burden.

“A stable environment where I can receive treatment in the area where I live” is the medical system that Yuna's family has always desired.

This is the change brought about by the Pediatric Hematology and Oncology Clinic at KNUH. And this change was led by Professor Shin Hee-young, a pediatric hematologist and oncologist who had treated pediatric cancer patients at Seoul National University Hospital (SNUH) for 33 years.

Professor Shin retired at SNUH in 2021 but volunteered to join KNUH in Chuncheon. She did so to change the reality of pediatric cancer treatment in the province where there were no pediatric hematology and oncology specialists, forcing patients to travel to Seoul.

Professor Shin sees pediatric cancer outpatients at KNUH every Wednesday and Friday. From January to June, she treated about 120 patients. These are pediatric cancer patients from all over Gangwon Province.

The changes in the pediatric cancer treatment system in Gangwon Province began with the “Pediatric Cancer Treatment System Establishment Project” launched by the Ministry of Health and Welfare in 2024. The government designated five regional pediatric cancer hub hospitals to address regional disparities in pediatric cancer treatment and divided the treatment system into three types: hub institution-type, regional open-type, and inter-regional support-type. It is currently in the process of recruiting and deploying personnel according to each type.

The model Professor Shin is participating in is the inter-regional support type, where the National Cancer Center, a hub hospital, dispatches pediatric hematology/oncology specialists to collaborating hospitals in regions with weak pediatric cancer care to support outpatient care for pediatric cancer patients in those areas.

Professor Shin began practicing at KNUH after retirement to establish a “safety net” for pediatric cancer patients.

“KNUH is a national university hospital with a children's hospital, but it cannot provide even outpatient treatment for pediatric cancer patients, which indicates issues with the medical system. I believed it was essential to start laying the groundwork for establishing a safety net through this initiative,” Professor Shin said.

Even if pediatric cancer patients receive chemotherapy in Seoul, their white blood cell counts may drop, causing fever, and they may need blood transfusions. If parents have to take time off work and travel to Seoul every time, they cannot sustain their livelihoods, Shin explained. Now, their children can receive injections within an hour, and their parents can return to work, which is a significant advantage for the families of pediatric patients, she added.

“The pediatric hematology and oncology department has few patients, requires a lot of staff, but has low reimbursement rates, so the more patients we see, the more we lose,” Professor Shin said, pointing out the structural issues in pediatric hematology and oncology care.

She emphasized the project’s significance, saying, “Although it is a loss, this project has raised awareness of the need to maintain the pediatric cancer treatment system, even with government support. This project has taken a meaningful first step.”

The Ministry of Health and Welfare is providing approximately 6 billion won ($4.3 million) in support for the construction project of the pediatric cancer treatment system. The government budget will cover personnel expenses necessary for the human resources core of restoring the pediatric cancer treatment system.

The more patients treated, the greater the deficit; how can a sustainable system be built?

However, the challenge lies in activating the pediatric cancer treatment system, which has begun to be restored through government budget allocation, and maintaining it as a sustainable system. Due to the nature of the project, which is extended on an annual basis, there is also uncertainty that it could be discontinued at any time.

Medical professionals in the field have suggested developing reimbursement rates to incentivize collaboration between tertiary hospitals and regional medical centers, thereby further activating the pediatric cancer treatment system, as well as providing support for nurses' salaries.

"Pediatric cancer treatment protocols are the same in Seoul and other regions. For example, after diagnosing a pediatric cancer patient, SNUH informs the patient's family about the treatment plan and refers them to a regional medical institution for further care. SNUH has nurses dedicated to checking treatment results every three months. If the government supports their wages, it would greatly help establish a nationwide network,” Shin said. “Establishing a system of linked fees for cases where patients are treated through a network of medical institutions is also necessary to activate the system."

Other experts also suggested that a “two-track” strategy is necessary to maintain a sustainable pediatric cancer treatment system, involving both government policy support and the cultivation of pediatric hematology and oncology specialists.

“There are about 1,200 pediatric cancer patients nationwide. The number of patients is not high. Moreover, the cure rate for pediatric cancer is over 80 percent,” National Cancer Center President Yang Han-kwang said. “If we treat them with care and they are cured, they can return to society, and we can also protect the families of children who have regained their health.”

Yang emphasized that this is a number that can be adequately managed at the national level. Given this country's economic strength, it can certainly establish a safety net to protect children with cancer.

“In the long term, it is time to start training pediatric hematology and oncology specialists at the national level to treat children with cancer. Above all, the government must create policies to build an environment where they can work with a sense of mission and pride," Yang added.