Treating Childhood Cancer in Low- and Middle-Income Countries

Gupta, Sumit; Howard, Scott C.; Hunger, Stephen P.; Antillón, Federico; Metzger, Monika L.; Israëls, Trijn; Harif, Mhamed; Rodríguez‐Galindo, Carlos

doi:10.1596/978-1-4648-0349-9_ch7

Cited by 105 publications

(132 citation statements)

References 129 publications

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“…5,7 Childhood cancers are often fatal without appropriate and timely diagnosis and treatment and, by contrast with adult cancers, there are no evidencebased population screening programmes or lifestyle risk-reduction strategies that are effective in improving outcomes. 8,9 As a result, increasing survival will require considerable planning by policy makers to ensure adequate resource allocation and health system function. Information on the burden of childhood cancer is crucial to informing these efforts and thus, model-based estimates are necessary to determine cancer burden in settings without data until cancer data coverage improves.…”

Section: Introductionmentioning

confidence: 99%

The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017

Force¹,

Abdollahpour²,

Advani³

et al. 2019

The Lancet Oncology

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238

143

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Background Accurate childhood cancer burden data are crucial for resource planning and health policy prioritisation. Model-based estimates are necessary because cancer surveillance data are scarce or non-existent in many countries. Although global incidence and mortality estimates are available, there are no previous analyses of the global burden of childhood cancer represented in disability-adjusted life-years (DALYs). Methods Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 methodology, childhood (ages 0-19 years) cancer mortality was estimated by use of vital registration system data, verbal autopsy data, and population-based cancer registry incidence data, which were transformed to mortality estimates through modelled mortality-to-incidence ratios (MIRs). Childhood cancer incidence was estimated using the mortality estimates and corresponding MIRs. Prevalence estimates were calculated by using MIR to model survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated by multiplying age-specific cancer deaths by the difference between the age of death and a reference life expectancy. DALYs were calculated as the sum of YLLs and YLDs. Final point estimates are reported with 95% uncertainty intervals. Findings Globally, in 2017, there were 11•5 million (95% uncertainty interval 10•6-12•3) DALYs due to childhood cancer, 97•3% (97•3-97•3) of which were attributable to YLLs and 2•7% (2•7-2•7) of which were attributable to YLDs. Childhood cancer was the sixth leading cause of total cancer burden globally and the ninth leading cause of childhood disease burden globally. 82•2% (82•1-82•2) of global childhood cancer DALYs occurred in low, low-middle, or middle Socio-demographic Index locations, whereas 50•3% (50•3-50•3) of adult cancer DALYs occurred in these same locations. Cancers that are uncategorised in the current GBD framework comprised 26•5% (26•5-26•5) of global childhood cancer DALYs. Interpretation The GBD 2017 results call attention to the substantial burden of childhood cancer globally, which disproportionately affects populations in resource-limited settings. The use of DALY-based estimates is crucial in demonstrating that childhood cancer burden represents an important global cancer and child health concern. Funding Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities (ALSAC), and St. Baldrick's Foundation.

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Section: Introductionmentioning

confidence: 99%

The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017

Force¹,

Abdollahpour²,

Advani³

et al. 2019

The Lancet Oncology

Self Cite

238

143

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“…20 Reducing mortality among children aged 5-14 years will require a broader set of interventions than those from the maternal and child health programmes targeting children younger than 5 years, including potentially curative treatment of several specific childhood cancers (most of which cannot be prevented, based on current knowledge). 21 The trends in homicide among boys aged 10-14 years in Brazil and Mexico are largely due to guns, and show a similar temporal pattern to young adults. 22 Action to reduce firearm-related deaths in children in Brazil and Mexico is also possible.…”

Section: Discussionmentioning

confidence: 98%

Trends in cause-specific mortality among children aged 5–14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies

Fadel

Boschi-Pinto

et al. 2019

The Lancet

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Background With global survival increasing for children younger than 5 years of age, attention is required to reduce the approximately 1 million deaths of children aged 5-14 years occurring every year. Causes of death at these ages remain poorly documented. We aimed to explore trends in mortality by causes of death in India, China, Brazil, and Mexico, which are home to about 40% of the world's children aged 5-14 years and experience more than 200 000 deaths annually at these ages. Methods We examined data on 244 401 deaths in children aged 5-14 years from four nationally representative data sources that obtained direct distributions of causes of death: the Indian Million Death Study, the Chinese Disease Surveillance Points, mortality data from the Mexican Instituto Nacional de Estadística y Geografía, and mortality data from the Brazilian Institute of Geography and Statistics. We present data on 12 main disease groups in all countries, with breakdown by communicable and nutritional diseases, non-communicable diseases, injuries, and ill-defined causes. To calculate age-specific and sex-specific death rates for each cause, we applied the national cause of death distribution to the UN mortality envelopes for 2005-16 for each country. Findings Unlike Brazil, China, and Mexico, communicable diseases still account for nearly half of deaths in India in children aged 5-14 years (73 920 [46•1%] of 160 330 estimated deaths in 2016). In 2016, India had the highest death rates in nearly every category, including from communicable diseases. Fast declines among girls in communicable disease mortality narrowed the gap by 2016 with boys in India (32•6 deaths per 100 000 girls vs 26•2 per 100 000 boys) and China (1•7 vs 1•5). In China, injuries accounted for the greatest proportions of deaths (20 970 [53•2%] of 39 430 estimated deaths, in which drowning was a leading cause). The homicide death rate at ages 10-14 years was higher for boys than for girls in Brazil, increasing annually by an average of 0•7% (0•3-1•1). In India and China, the suicide death rates were higher for girls than for boys at ages 10-14 years. By contrast, in Mexico it was higher for boys than for girls, increasing annually by an average of 2•8% (2•0-3•6). Deaths from transport injuries, drowning, and cancer are common in all four countries, with transport accidents among the top three causes of death for both sexes in all countries, except for Indian girls, and cancer in the top three causes for both sexes in Mexico, Brazil, and China. Interpretation Most of the deaths that occurred between 2005 and 2016 in children aged 5-14 years in India, China, Brazil, and Mexico arose from preventable or treatable conditions. This age group is important for extending some of the global disease-specific targets developed for children younger than 5 years of age. Interventions to control noncommunicable diseases and injuries and to strengthen cause of death reporting systems are also required. Funding WHO and the University of Toronto Connaught Global Challenge.

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“…This is not surprising considering how rapidly Burkitt lymphoma can grow, such that any treatment gaps provide an opening for disease to progress (Patte et al , ). The intense block regimens in HIC include high‐dose methotrexate, alkylating agents, anthracyclines, vincristine, glucocorticoids and intrathecal methotrexate in doses that induce severe neutropenia, lymphopenia, thrombocytopenia and mucositis, requiring intense supportive care including management of infection, haemorrhage, drug‐specific toxicities and nutrition (Patte et al , ; Howard et al , , ; Gavidia et al , ; Israels et al , ; Bhojwani et al , ; Gupta et al , ; Ladas et al , ). Patients usually develop profound aplasia and opportunistic infections, which necessitate rapid access to intensive life‐support.…”

Section: Protocol‐based Carementioning

confidence: 99%

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

2019

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In high-income countries, more than 90% of children with mature B-cell lymphomas are cured with frontline therapy. However, cure requires prompt and correct diagnosis, careful risk stratification, very intense chemotherapy and meticulous supportive care, together with logistical support for patients who live far from the cancer centre or face financial barriers to receiving care. In low-and middle-income countries (LMIC), cure rates range from 20% to 70% because of lack of diagnosis, misdiagnosis, abandonment of treatment, toxic death and excess relapse with reduced-intensity regimens. Fortunately, a wide range of successful interventions in LMIC have reduced these causes of avoidable treatment failure. Public awareness campaigns have led to societal awareness of childhood cancer; telepathology has improved diagnosis, even in remote areas; subsidized chemotherapy, transportation, housing and food have reduced abandonment; and hand hygiene, nurse training programmes and health system improvements have reduced toxic death. These interventions can be deployed everywhere and at low cost, so are highly scalable. Children and adolescents with Burkitt lymphoma can be cured in all countries by making a timely correct diagnosis, applying protocols adapted to the local context, preventing abandonment of therapy and avoiding toxic death. Reducing these causes of treatment failure is feasible and highly cost-effective everywhere.

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Treating Childhood Cancer in Low- and Middle-Income Countries

Cited by 105 publications

References 129 publications

The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017

The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017

Trends in cause-specific mortality among children aged 5–14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies

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

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