Background: Paediatric oncologists routinely face emotionally demanding situations, including prolonged exposure to child suffering, ethically complex decision‐making, and high clinical workloads. These stressors contribute to burnout, moral distress, and psychological strain, yet their lived experiences remain underexplored. Objective: To synthesise existing evidence on the psychological challenges experienced by paediatric oncologists, with a focus on burnout, emotional exhaustion, moral distress, and coping strategies. Methods: A scoping review was conducted using the Joanna Briggs Institute methodology and reported in accordance with PRISMA‐ScR guidelines. Five databases [PubMed, ProQuest, Scopus, Web of Science, and CINAHL] were searched for English‐language studies published between 1992 and April 2025. Fourteen studies met the inclusion criteria [5 qualitative, 8 quantitative, 1 mixed‐methods]. Results: Key psychological stressors included emotional exhaustion, depersonalisation, moral distress, and job dissatisfaction. Coping strategies ranged from peer support and physical activity to institutional interventions such as debriefing sessions and resilience training. Stigma surrounding help‐seeking and systemic barriers to emotional support were recurrent themes. Conclusion: Burnout in paediatric oncology is a multifaceted phenomenon shaped by personal, ethical, and organisational factors. Addressing these challenges requires both individual‐level coping mechanisms and systemic reforms, including trauma‐informed leadership, confidential mental health support, and the redistribution of workloads. Future research should explore longitudinal outcomes and culturally diverse experiences to inform targeted interventions.

The development of antibodies to therapeutic factor VIII, known as inhibitors, is a leading cause of morbidity and mortality in people with haemophilia. This is particularly challenging in areas where access to novel treatment options is limited. This case report presents a clinical scenario in South Western India involving a 16-year-old male with severe haemophilia A with high titre inhibitors, who sustained a tibia-fibula shaft fracture necessitating emergency surgical intervention. The successful management of this patient required a multidisciplinary approach, encompassing haemostasis optimisation, innovative factor replacement strategies to work around financial constraints, and a comprehensive rehabilitation plan. The patient’s history of multiple factor VIII concentrate transfusions contributed to inhibitor development. Limited funds for bypassing agents prompted the utilisation of fresh frozen plasma to achieve haemostasis before access to FEIBA and recombinant factor VII. Emicizumab, a subcutaneously administered bispecific antibody, was used to assist perioperative haemostasis. A comprehensive rehabilitation plan with regular physiotherapy was followed. Emicizumab prophylaxis was initiated and the patient now shows improvement. This case emphasises the importance of novel treatment options such as FEIBA and emicizumab in dealing with complications in haemophilia such as inhibitors. In resource-limited settings, there is still a need to improve the availability of these life-saving interventions to optimise surgical outcomes in such cases.

Childhood cancers have excellent outcomes in terms of cure rates and survival if they are diagnosed early and treated appropriately. However, there is a huge disparity in outcomes between high- and low-middle income country(ies) due to out-of-pocket expenditure, therapy abandonment, and severe infections. To bridge these gaps in outcomes, a partnership between a private medical institute and a nongovernmental organization was fostered to develop a long-stay facility for children with cancer and their families while receiving disease-directed therapies. This report aims to expound the story of development of the “Home Away from Home” program and its transformative potential and societal impact.

Introduction L-asparaginase is considered to be the most important component in the treatment of acute lymphoblastic leukemia (ALL). Intensifying the use of L-asparaginase during treatment for ALL has resulted in a significant rise in the percentage of children and adolescents who are cured of the disease. Asparaginase trough activity more than or equal to 100 IU/L on day 7 has been found to be the desired activity level in all childhood leukemia patients. Objectives Due to the paucity of data on biosimilar pegaspargase in the upfront setting, we planned this prospective pilot study to evaluate the levels of serum asparaginase activity (SAA) after biosimilar pegaspargase infusion. Materials and Methods It is a prospective, single-center, pilot study of 10 pediatric ALL patients for the duration of 6 months. All children less than 18 years with ALL on treatment with curative intent and receiving pegaspargase and who provided informed consent were included in this study. The enzymatic spectrophotometric method was used to determine SAA, and it was measured on the 7th and 14th days after the first dosage of pegaspargase-asparaginase, as well as on the 14th day after the second dose of pegaspargase-asparaginase, while toxicity was charted according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Results From 10 patients with a median age of 5.5 years, a grand total of 29 samples were taken for analysis. Children who received pegaspargase had either B-ALL or T-ALL. After the first dose, mean ± SD (standard deviation), SAA levels at day 7 was 131.3 ± 38 IU/L and at Day 14 was 94.8 ± 8 IU/L. After the second dose, mean ± SD SAA level at day 14 was 86.1 ± 15 IU/L. No patient had clinical hypersensitivity reaction and no patient reported any asparaginase-related toxicity. One patient died due to sepsis, infection with multidrug-resistant gram-negative bacteria. Conclusions Biosimilar pegaspargase maintained good SAA levels 7 and 14 days after infusion. Drug Trial Registration: Clinical Trial Registry of India vide reference CTRI/2021/08/036033 and available at https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=59285&EncHid=&userName= The abstract of this text was published in the Supplementary issue: Abstracts of the 25th Annual Conference of the Pediatric Hematology Oncology chapter of the Indian Academy of Pediatrics (PHOCON 2022), N Delhi in November 2022 with doi: 10.1016/j.phoj.2022.10.176 The manuscript has been read and approved by all the authors, that the requirements for authorship (Pg. 18) have been met, and that each author believes that the manuscript represents honest work, if that information is not provided in another form. None. This study was approved by Institutional Ethics Committee at Kasturba Hospital, Manipal and the procedures used in this study adhere to the tenets of the Declaration of Helsinki. All procedures performed in studies involving human participants were in accordance with the ethical standards and by approval from the Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee (DHR Registration No. EC/NEW/INST/2019/374, Dated 14^th April 2021, IEC: 356/2021) and was registered at CTRI- REF/2021/08/046121. It was performed in line with the latest Helsinki Declaration's guiding principles from 2013. Vasudeva Bhat K conceptualized and designed the study. Archana M.V., Arjun Asok, and Krishnananda Prabhu helped in data acquisition and manuscript preparation. Article published online: 18 September 2023 © 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India