Translating the science of care and cure for children with cancer

Abstract

The past 50 years have seen great progress for children with cancer, and yet, this progress has been largely unreached for most children. We examine how global efforts aimed at spreading, scaling, and sustaining interventions to improve access, quality, and integration in systems and policies can transform the landscape.

Figure 1

Translating our vision of childhood cancer outcomes from 2D to 3D (A) Conventional 2D view: x and y axes (Number of children and survival, respectively). Like a black box, no additional insights are offered into possible factors why survival may be stagnant despite interventions. (B) Transformed 3D lens through systems thinking: x, y, and z axes (via spreading, scaling, and sustaining interventions, to increase overall impact, via increased access, quality, and systems and policy integration, respectively). This three-dimensional view can help us understand why survival sometimes remains stagnant. Settings with interventions enabling stronger access to care, higher quality services, and supportive systems and policies are more likely to achieve and sustain better survival rates. Conversely, in contexts where one or more of these dimensions are neglected, short-term survival gains may soon lapse. Designing strategies that address all three dimensions can help us improve survival for more children to a greater extent over time. 2D, two-dimensional; 3D, three-dimensional. Graphics used with permission of Dr. Catherine G. Lam.

Figure 2

Translating disparities into a common language to engage stakeholders in spreading, scaling, and sustaining interventions (A) The Health Systems Plus framework supports teams to identify opportunities to connect stakeholders and align interventions for care improvement beyond service delivery. (B) The related dimensions of the CureAll framework underpinning the WHO Global Initiative for Childhood Cancer anchors teams in cross-cutting systems strengthening opportunities. (C) The color legend shows the intentional design architecture linking both frameworks. WHO, World Health Organization. Graphics used with permission of Dr. Catherine G. Lam.