Childhood cancer treatment is truly a miracle of modern medicine; what only decades ago was a uniformly fatal disease is now curable in 80% of children. Yet, major challenges remain, including decreasing the burden of chronic morbidity in childhood cancer survivors and developing novel treatments to cure the remaining 20% of cases.
There is a fundamental flaw in the above statements. Only children with access to modern therapies have the potential for cure; more than 80% of children live in countries with limited resources, where access to cancer care is limited to non-existent. In fact, the majority of children diagnosed with cancer today worldwide will die.
Thus, we would argue that the single biggest challenge globally is ensuring that all children with cancer, regardless of where they live, have access to the best treatment available. For most people, treating childhood cancers in low- and middle-income countries (LMICs) is not an intuitive fit. The following questions, or variations thereof, are ones that we are often asked:
In fact, childhood cancer represents a bigger and bigger cause of overall childhood mortality in LMICs. Remember that in high-income countries (HICs), cancer is the main cause of disease-related death in children. As LMICs continue to economically develop and make strides against traditional childhood illness like pneumonia, diarrhoea and malnutrition, childhood cancer treatment will be necessary in order to further decrease childhood mortality. Now is the time to start building the infrastructure and human capacity necessary to deliver such treatment. It’s also worth noting that in upper-middle income countries, including the vast populations of Brazil and China, almost 20% of deaths in children between the ages of 5 and 14 years are already estimated to be due to cancer.
Not at all. There are countless examples of LMIC centers around the world that have made great strides in curing children with cancer, from cure rates of above 60% in leukemia in Central America to 50% cure rates for Burkitt lymphoma in Sub-Saharan Africa, using simple and limited therapy. Sometimes, but not always, partnered with HIC institutions and individuals, these pioneers have shown us what is possible even in the most resource-constrained settings. Indeed, though formal health economic evaluations are rare, preliminary work suggests that childhood cancer treatment in LMICs is very cost-effective, comparable or even exceeding the cost-effectiveness of, for example, HIV treatment.
The above examples represent islands of excellence. Our challenge as a community is to take the examples they have provided and extend them to cover LMIC populations as a whole. This will take a concerted effort not only from clinicians, but also from survivors, parents, advocates, and policymakers at both the national and international level. The recent adoption of the Cancer Resolution at the 70th World Health Assembly, which makes specific note of the need to address childhood cancer, is a tremendously exciting new development, but only if it catalyses real action.
To further galvanise efforts in LMIC childhood cancer, we and numerous partners have come together in an effort to, for the first time:
The results will form the core of an upcoming Lancet Oncology Commission, due to be launched in 2018. Our hope is that the Commission will serve as both an advocacy tool and a roadmap for future efforts to improve global childhood cancer outcomes.
A dream becomes a goal when action is taken toward its achievement.
Though found in a self-help book, the quote resonates. An equal chance of cure for all children with cancer, regardless of where they live, may seem like a dream, but concrete steps have already been taken by many to turn this dream into a reality. While there is still far to go, we are confident that, through vision and collaboration, our community can achieve this goal within our lifetimes.
Read more about the Lancet Oncology Commission on Sustainable Paediatric Cancer Care here.