Global Access to Essential Medicines for Childhood Cancer: A Cross-Sectional Survey

Abstract

Purpose Global data mapping access to essential chemotherapeutics for pediatric cancer are scarce. We report a survey of international pediatric cancer care providers’ access to these medicines. Methods A Web-based survey was sent to pediatric oncologists registered on the Cure4Kids Web portal. We queried chemotherapeutics in the WHO Essential Medicines List for Children, from which the average proportional availability was summarized as each country’s access score. In addition, we examined availability of drug packages defined by the WHO-sanctioned Expert Committee for eight pediatric cancers. We undertook a sensitivity analysis investigating how regimen access would change if the cytotoxics specified in recent agreements between the Clinton Health Access Initiative, American Cancer Society, and pharmaceutical companies were universally available. Results There were significant ( P < .001) differences in the median access scores between World Bank income groups, and 42.9% of respondents from low-income and lower middle–income countries reported suboptimal access scores. Our disease-based analysis revealed that 42.1% of patients in low-income and lower middle–income countries lacked full access to chemotherapy packages. Guaranteed availability of the cytotoxics specified in the Clinton Health Access Initiative/American Cancer Society agreements was projected to increase this regimen-based access by 1.6%, although including four additional chemotherapeutics would further increase coverage by 13.9%. Conclusion This study is the first, to our knowledge, to assess worldwide variation in practical access to pediatric chemotherapy. Although mapping the proportion of available chemotherapeutics is informative, we also developed a meaningful estimate of access using disease-specific drug packages. These data provide an important baseline for continued monitoring and can aid in planning adaptive treatment guidelines that consider the trade-offs between access and outcomes.

Science and health for all children with cancer

“…In LMIC, many factors unrelated to the treatment regimen also increase relapse risk, including unavailability or unaffordability of medicines, lack of adherence to treatment, and lack of infrastructure and support to families that enable treatment completion ( Fig. 3) (35,(51)(52)(53)(54)(55). Ideally, these factors should be considered in the planning of adapted treatment regimensfor instance, by planning medicines that can be substituted for commonly unavailable or unaffordable medicines, or including funding for a clinical coordinator/patient navigator to help reinforce adherence to the treatment regimen.…”

“…As more children survive cancer, policies can also stipulate resources to support the distinct needs of children and families affected by a chronic illness like cancer, while strengthening local capacity to prevent, monitor, and manage late effects of treatment amongst survivors (76)(77)(78). Recent analyses suggest an ongoing need for implementation research within countries to facilitate access to the recommended medicines, particularly in resource-limited settings (54,80).…”

Optimizing outcomes for children with non‐Hodgkin lymphoma in low‐ and middle‐income countries by early correct diagnosis, reducing toxic death and preventing abandonment

“…However, this interval between cycles is, in practice, typically longer in LMIC (Chantada et al , ). Finally, relapse risk can be increased by factors unrelated to the treatment regimen, including drug shortages, lack of adherence and decreased dose‐intensity due to comorbid illness, all of which occur more commonly in LMIC (Fig ) (Cohen et al , ; Khetrapal Singh & Travis, ; Perehudoff et al , ; Roth et al , ). Fortunately, many interventions have been documented to decrease each cause of treatment failure (see Fig for examples).…”

Global childhood cancer survival estimates and priority-setting: a simulation-based analysis

“…5 However, due to the paucity of cancer registry data from resource-limited settings, only a small subset of CONCORD-3 data (7/322 registries) are from lowincome and lower middle-income countries. Disparities in treatment access, 6 quality, 2 and financial toxicity 7 all contribute to the large global variations in childhood cancer outcomes. [2][3][4][5]8,9 In order to quantify the survival gap and identify opportunities for intervention, we developed a simulation model that synthesizes clinical, epidemiologic, and health system data to estimate country-specific childhood cancer survival.…”