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The burden of childhood cancer

Cancer. Concept. Chemotherapy. Medical devices for advanced chemotherapy. By 2040, 670,000 Indians will need to be treated with chemotherapy for cancer. Every day, 90,000 children are diagnosed with cancer. Childhood cancer concept.
Medical devices for advanced chemotherapy. By 2040, 670,000 Indians will need to be treated with chemotherapy for cancer. Every day, 90,000 children are diagnosed with cancer. 

Childhood cancer leads to 11.5 million years of healthy life being lost every year, new research published in The Lancet reveals. India ranks among those countries most affected by childhood cancer.

The study marks the first time loss of healthy life due to cancer in adolescents and children has been conveyed through disability-adjusted life years (DALYs) – defined by the World Health Organization (WHO) as “the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences.” In effect, the WHO states, “one DALY can be thought of as one lost year of “healthy” life.” 

According to the research, which was jointly conducted by St Jude Children’s Research Hospital and the Institute for Health Metrics and Evaluation, 97 percent of the healthy life lost is due to premature death. The remaining three percent is the consequence of physical impairment resulting from the condition. 

Every day, 700 children are diagnosed with cancer worldwide. Overall, childhood cancers account for the sixth largest contributor to the global burden of cancer, behind cancers of the lungs, liver, stomach, colon, and breast. In addition, childhood cancer is the ninth biggest cause of illness in childhood. 

Childhood cancer in countries at lower levels of economic development account for the overwhelming majority of cases – more than 82 percent – and consequently account for almost 9.5 million years of healthy life lost. Significant disparities were noted when it comes to survival rates: whilst eighty percent of patients in high-income countries survived for five years after diagnosis, the five-year survival rate in low- and middle-income countries could be as low as twenty percent. Children diagnosed in low- and middle-income countries are four times more likely to die of cancer, with LMICs home to ninety percent of the children at risk of developing cancer. 

The Regional Cancer Centre in Trivandrum. Cancer infrastructure in India is lacking, jeopardising efforts for timely diagnosis of childhood cancer cases.

Writing in a linked comment, Charles A. Stiller of the National Cancer Registration and Analysis Service at Public Health England in the United Kingdom noted the difficulties childhood cancer cases pose: “Childhood and adolescent cancer is much less amenable to prevention than many major cancers of adults, for which risk factors can be reduced or even eliminated.” Accordingly, Stiller says “earlier diagnosis through greater public and clinical awareness could bring a short-term rise in global burden for children and adolescents…overall, however, early diagnosis can bring substantial reductions in mortality and long-term morbidity.” He added that “gains from early diagnosis should be greatest in lower-resource countries, where too many cases are diagnosed at a late stage.”

It was noted, however, that in poorer countries, data is lacking, which can make addressing the burden of paediatric cancer difficult. “The GBD 2017 results highlight that improving the accuracy of global childhood cancer burden assessment will require not only expanding the quantity and quality of population-based cancer registration systems, but also increasing access to health care with the capacity to identify children with cancer regardless of where they live,” the authors note in the paper. 

“The universal language of data offers a substantial opportunity to those fighting the global burden of childhood cancer. Analysis of the DALY burden by individual country and cancer subtype shows the significant need for investment in data capture,” asserted an accompanying editorial. “Quality data collection and standardised reporting are crucial early strides towards better care provision for children with cancer in LMICs.”

Leukemia is the main contributor to years of healthy life lost due to childhood cancer.

Globally, the main contributor to DALYs was leukemia, which accounts for 34 percent of childhood cancer cases, followed by cancers of the brain and nervous system, which account for eighteen percent. India ranks among the countries with the highest burden of childhood cancer and, for many cancers, it accounts for the highest burden of years of healthy life lost when ranked “vertically…between the SDI [Socio-demographic Index] quintiles, between the GBD [global burden of disease] super-regions, and between countries.” India ranked first for the number of DALYs resulting from acute lymphoblastic leukaemia, acute myeloid leukaemia, and other rare cancers; second for DALYS resulting from cancers of the brain and nervous system, other leukaemias, and uncategorised cancers; and third for DALYS resulting from Hodgkin lymphoma, non-Hodgkin’s lymphoma, liver cancers, and renal cancers. 

Cancer is one of the major public health challenges facing India. The country is home to the third largest number of people with cancer in the world and the burden is projected to increase in the coming years, with 670,000 new cases of cancer requiring chemotherapy expected by 2040. In India, around 50,000 adolescents and children are diagnosed with cancer each year according to the Indian Cancer Society. 

The study serves as a reminder of the crisis of noncommunicable diseases plaguing India, affecting all members of society whether young or old. Ensuring that India has the oncology workforce and healthcare infrastructure to cope with its burden of childhood cancer, offering timely diagnosis and treatment to all, is vital. 

“By assessing the global burden of childhood cancer through the lens of disability-adjusted life-years, we can more comprehensively understand the devastating impact of cancer on children globally,” said Dr Lisa Force of St Jude Children’s Research Hospital. “Our findings are an important first step in establishing that childhood cancer has a role in frameworks that address global oncology and global child health.

“Improving childhood cancer survival will require considerable planning by policy makers to ensure well-functioning health systems capable of early diagnosis and treatment. Estimating the years of healthy life children have lost due to cancer allows policymakers to compare the lifelong implications of childhood cancer with other diseases, potentially helping them determine the most effective way to spend limited resources and identify high-impact cancer-control planning decisions.” 

“The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017”, published in The Lancet, can be accessed here.

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