Don’t Forget About the Children
By Uduak Thomas, M.A.
An article that appeared in Nature News recently highlighted a series of four studies covering various aspects of pediatric cancer that were published in The Lancet Oncology journal. According to these studies, 94 percent of children worldwide aged 0-14 years who die from cancer are in low- and middle-income countries with the usual suspects — poverty, few health-care providers, weak health systems, and poor access to education, modern technology, and health care — named as the culprits. That’s a very different picture from high-income countries where childhood cancer survival rates stand at about 80 percent, according to the researchers.
It’s quite clear why children in high-income countries do better than their counterparts in resource limited settings. There’s more research that’s done here and abundant financial and human resources that has been poured into cancer studies and treatment development. A simple Google search today will yield all sorts of scientific efforts in the US and other countries of the first world that focused on fighting pediatric cancers. One example is a joint effort of the National Cancer Institute and the Cancer Therapy Evaluation Program dubbed Therapeutically Applicable Research to Generate Effective Treatments, or TARGET, initiative, which is using genomics technologies to identify biomarkers that could be used to develop new and more effective treatments for childhood cancers such as acute lymphoblastic leukemia and neuroblastoma.
Now, do a second Google search this time for cancer research in the third world and you’ll find next to nothing being done at the local level — what little there is mostly being conducted by scientists from higher-income countries. That’s not to say that there aren’t praiseworthy efforts going on at the global level. One of these is the International Confederation of Childhood Cancer Parent Organizations (ICCCPO), which initiated the International Childhood Cancer day on February 15 to raise worldwide public awareness of childhood cancer; and continues working to improve access to treatment and care for children with cancer globally. Another organization is the International Cancer Center, Mahatma Gandhi Memorial Medical Trust, in India, which combines radiation therapy with public health education about cancer prevention.
Meanwhile, the World Health Organization’s International Agency for Research on Cancer is also paying attention. They are working on a document that will provide data on cancer incidence in children and adolescents from around 200 areas worldwide. It’s also working with the Automated Childhood Cancer Information System (ACCIS) to do comparative analyses of cancer incidence and survival in European children and adolescents; and with the European Network for Cancer Research in Children and Adolescents (ENCCA) to explore the possibility of collecting clinically relevant information from population-based cancer registries. They eventually hope to be a resource for researchers and public health policy-makers on incidence, mortality, and survival data for childhood cancer.
The benefits of pediatric cancer research and changes in health policies will eventually make their way down to poorer nations of the earth but that’s going to take awhile. Children in countries in much of Africa, Asia, even parts of Europe that don’t have access to these treatments and who cannot afford the costs of care and treatment cannot wait.
In their paper, Pritchard-Jones et al offer some suggestions for short term improvements. They write that in poorer countries the priority should be “to improve access to an affordable, best standard of care in each country.”
“Every country should have a national cancer plan that recognizes the unique demographic characteristics and care needs of young people with cancer,” they said.
Furthermore, “referral routes and care pathways must take account of the large geographical distances between many patients’ homes and treatment centers, and the economic, cultural, and linguistic diversity of the populations served,” they said.
For their part, Magrath et al write that more public education, better-trained health professionals, locally relevant research, regional hospital networks, international collaboration, and health insurance are factors that need to be addressed.
Uduak Thomas, M.A., is a journalist and science writer specializing in medical research and healthcare. She is Social Media Editor for Cancer InCytes Magazine.
Sustaining innovation and improvement in the treatment of childhood cancer: lessons from high-income countries
Prof Kathy Pritchard-Jones PhD,Prof Rob Pieters PhD,Prof Gregory H Reaman MD,Lars Hjorth PhD,Peter Downie MD,Gabriele Calaminus MD,Marianne C Naafs-Wilstra MA,Eva Steliarova-Foucher PhD
The Lancet Oncology – 20 February 2013 DOI: 10.1016/S1470-2045(13)70010-X
Paediatric cancer in low-income and middle-income countries
Prof Ian Magrath DSc [Med],Eva Steliarova-Foucher PhD,Sidnei Epelman MD,Prof Raul C Ribeiro MD,Prof Mhamed Harif MD,Prof Chi-Kong Li MD,Prof Rejin Kebudi MD,Scott D Macfarlane MBChB,Prof Scott C Howard MD
The Lancet Oncology – 20 February 2013 DOI: 10.1016/S1470-2045(13)70008-1
New drugs for children and adolescents with cancer: the need for novel development pathways
Prof Gilles Vassal MD PhD,C Michel Zwaan MD PhD,Prof David Ashley MD PhD,Marie Cecile Le Deley MD PhD,Darren Hargrave MD PhD,Patricia Blanc MIM,Peter C Adamson MD
The Lancet Oncology – 20 February 2013 DOI: 10.1016/S1470-2045(13)70013-5
New policies to address the global burden of childhood cancers
Prof Richard Sullivan MD,Prof Jerzy R Kowalczyk MD,Bharat Agarwal MD,Prof Ruth Ladenstein MD,Edel Fitzgerald PhD,Prof Ronald Barr MD,Eva Steliarova-Foucher PhD,Prof Ian Magrath MD,Scott C Howard MD,Prof Mariana Kruger MD,Maria Grazia Valsecchi MD,Prof Andrea Biondi MD,Paul Grundy MD,Malcolm A Smith MD,Peter Adamson MD,Prof Gilles Vassal MD,Prof Kathy Pritchard-Jones MD
The Lancet Oncology – 20 February 2013 DOI: 10.1016/S1470-2045(13)70007-X