Toward the Cure of All Children With Cancer Through Collaborative Efforts: Pediatric Oncology As a Global Challenge

Abstract

Advances in the treatment of childhood cancers have resulted in part from the development of national and international collaborative initiatives that have defined biologic determinants and generated risk-adapted therapies that maximize cure while minimizing acute and long-term effects. Currently, more than 80% of children with cancer who are treated with modern multidisciplinary treatments in developed countries are cured; however, of the approximately 160,000 children and adolescents who are diagnosed with cancer every year worldwide, 80% live in low- and middle-income countries (LMICs), where access to quality care is limited and chances of cure are low. In addition, the disease burden is not fully known because of the lack of population-based cancer registries in low-resource countries. Regional and ethnic variations in the incidence of the different childhood cancers suggest unique interactions between genetic and environmental factors that could provide opportunities for etiologic research. Regional collaborative initiatives have been developed in Central and South America and the Caribbean, Africa, the Middle East, Asia, and Oceania. These initiatives integrate regional capacity building, education of health care providers, implementation of intensity-graduated treatments, and establishment of research programs that are adjusted to local capacity and local needs. Together, the existing consortia and regional networks operating in LMICs have the potential to reach out to almost 60% of all children with cancer worldwide. In summary, childhood cancer burden has been shifted toward LMICs and, for that reason, global initiatives directed at pediatric cancer care and control are needed. Regional networks aiming to build capacity while incorporating research on epidemiology, health services, and outcomes should be supported.

Fig 1.

Global distribution of childhood cancer by region. Source: World Bank Databank and GLOBOCAN 2012.

Fig 2.

The mortality rate for children younger than age 5 years (under-5 mortality rate [U5MR]), childhood cancer incidence, and childhood all-cancer mortality by region. U5MR and cancer incidence show opposite linear trends: as U5MR decreases, cancer incidence increases (r² = −0.617). Sources: World Bank Databank for U5MR and GLOBOCAN 2012 for age-specific (0 to 14 years old) cancer incidence and mortality.

Fig 3.

Regional collaborative efforts identified the expected proportion of childhood cancer covered by each consortium (total, 58.5%). The Chinese Childhood Cancer Group (CCCG) and India's Indian Cooperative Oncology Network (ICON) are included, despite being national rather than international consortia, based on the size of the population they cover. India is also a member of Pediatric Oncology East and Mediterranean (POEM) Group, but case contribution is included only once (for ICON). Algeria, Morocco, and Tunisia are members of the Franco-African Group of Pediatric Oncology (GFAOP) and POEM; their case contribution is included only once (for POEM). Source: World Bank Databank and GLOBOCAN 2012. AHOPCA, Central American Association of Pediatric Hematology and Oncology; GALOP, Latin American Pediatric Oncology Group; VIVA, VIVA Foundation for Children with Cancer in Singapore.