By 2050, the world is expected to register 13.7 million new cases of childhood cancer – and without scaling up investments, cancer will kill 11.1 million children.
These are the findings of a landmark report released earlier this week by the Lancet Oncology Commission, a report bringing together the insights of 44 leading experts from across the globe including economists, oncologists, paediatricians, and public health experts. The report indicates that low- and middle-income countries (LMICs) will bear the brunt of the increased burden of childhood cancer and mortality in the coming decades, with 9.3 million (84.1 percent) of the 11.1 million projected deaths sans additional investment occurring in these nations. Yet, the report emphasises, it does not have to be that way.
Scaling up investments in tackling childhood cancer could avert 6.2 million deaths due to childhood cancer in the 2020-50 period, the report suggests. Meanwhile, “new funding to scale up cost-effective interventions” could also “vastly [reduce]” the burden of childhood cancer-related mortality borne by LMICs.
Childhood cancer is a global health issue of considerable magnitude, including – if not especially – in LMICs. As previously noted by Health Issues India, “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.”
The Lancet Commission’s report identifies “unacceptable inequalities in access to cancer prevention, treatment, and care for adults and children, with wide disparities in mortality and survival. Although…LMICs account for about eighty percent of the global cancer burden, the financing for cancer care in these countries only amounts to five percent of the resources allocated to cancer care globally.” In the case of childhood cancer, Health Issues India noted that “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 impetus to invest in fighting childhood cancer ought to be adopted by stakeholders at the global level, the Lancet Commission report notes. Such investments and the reductions in childhood mortality due to cancer do not constitute an economic drain. In fact, the report stipulates, “the global lifetime productivity gains of US$2580 billion in 2020-50 would be four times greater than the cumulative treatment costs of $594 billion, producing a net benefit of $1986 billion on the global investment.” Put simply, for every US$1 invested in the fight against childhood cancer in this timeframe, a return can be expected of US$3.
“For too long, there has been a widespread misconception that caring for children with cancer in…LMICs is expensive, unattainable, and inappropriate because of competing health priorities,” comments Commission co-chair Professor Rifat Atun of the Harvard T. H. Chan School of Public Health. In fact, he says, “nothing could be further from the truth.” In actuality, “this report provides compelling evidence that improving outcomes for children with cancer is both feasible and a highly cost-effective investment for all countries rich and poor alike.
“Expanding access to achievable diagnostics, treatment, and supportive care, alongside strengthening health systems more widely, could prevent more than six million child deaths and bring almost US$2 trillion in economic benefits over the next thirty years. The time is right for a global push to expand coverage of care for children with cancer.”
Noncommunicable diseases (NCDs) as a public health challenge no longer exist as a prerogative of the more-economically-developed world, but are increasingly being felt by LMICs. India stands as a case in point, with NCDs now accounting for a majority of deaths in the country compared to communicable conditions. Cancer ranks as the second-highest cause of death in the country.
India is one of the countries most-affected by childhood cancer and the Lancet Commission report highlights the performance of India on addressing the issue. Concerningly, the report states that “childhood cancer is not prioritised by the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases, and Stroke, or by the National Cancer Control Programme of the Ministry of Health and Family Welfare.” Consequently, “alternative governance and care delivery models have emerged for childhood cancers, which include a mixture of public, private, philanthropic, and state actors.”
The report spotlights the Mumbai-based Tate Memorial Centre, which “operates as a centre of excellence, with modern facilities that provide high-quality clinical services and research pertaining to children with cancer…the Improving Pediatric Cancer Care and Treatment Foundation at the Tata Memorial Centre, which is funded by philanthropic sources, enables access to comprehensive cancer care for children, regardless of socioeconomic background, by defraying medical costs, providing nutritional support for patients, and organising free accommodation with psychosocial services for caregivers – an holistic approach that helps to reduce the abandonment of treatment.”
The Commission’s report identifies treatment abandonment as a key issue, describing it as “a major cause of therapeutic failure in countries with limited resources, where children and families incur unaffordable direct and indirect costs of care.” India is no stranger to out-of-pocket spending on healthcare, which is a major scourge among the citizenry: some estimates pinpoint out-of-pocket spending on healthcare to comprise almost as much as eighty percent of the total spending on health in India. In the case of cancer, out-of-pocket spending accounts for as much as three-quarters of the total expenditure on cancer care.
The report goes on to note, however, that India – alongside El Salvador and Guatemala – presents how “prioritisation of the development of programmes to address refusal and abandonment of care has resulted in substantial improvements of treatment outcomes, highlighting the critical role of psychosocial packages in comprehensive childhood cancer care.” There is room for potential, it seems – but ensuring that childhood cancer is afforded the necessary priorities from policymakers and other stakeholders is necessary to save lives, reduce suffering, and improve treatment outcomes.
“The stark reality is worldwide inequity and a bleak picture for children with cancer in low- and middle-income countries,” comments Dr Ramandeep Arora of the Max Super-Speciality Hospital in India and a Commission co-author. “So far investment targeted to childhood cancer in developing countries has been minuscule. Yet childhood cancer is no longer complex, expensive, difficult to diagnose, or complicated to treat. Outcomes for children in low- and middle-income countries could be dramatically improved by addressing key issues such as delayed diagnosis and lack of access to essential medicines.”
At present, according to Commission co-author, Dr Agnes Binagwaho, Vice-Chancellor of the University of Global Health Equity in Rwanda, “health systems are ill-prepared to meet this unprecedented challenge, particularly in low- and middle-income countries where treatment for paediatric cancer is often managed through charitable partners.” The need of the hour is investment in childhood cancer which, according to Commission co-author Dr Carlos Rodriguez-Galindo of St Jude Children’s Research Hospital in the United States, is necessary to attain the Sustainable Development Goals.
LMICs will bear the brunt of childhood cancer in the years to come. “There will be an estimated 413,000 new cases of children with cancer worldwide in 2020,” the report says. It goes on to note that “globally there will be 13.7 million cases of childhood cancer between 2020 and 2050” of which 6.9 million will be in LMICs. Access to diagnostics at present – “including access and referral’ means that 6.1 million (translating to 44.9 percent) of childhood cancer cases in the 2020-50 period will go undiagnosed.
The report identifies six key actions
- 1) Make childhood cancer an integral part of essential benefits packages when expanding universal health coverage
- 2) Develop fully costed national cancer control plans for LMICs
- 3) End out-of-pocket costs for children with cancer to prevent treatment abandonment
- 4) Establish national and regional cancer networks to increase access to effective services
- 5) Expand the quality and quantity of population-based cancer registries that include data on childhood cancers
- 6) Invest in research and innovation in LMICs, supported by a new global coalition fund of US$100 million per year
These ought to be heeded. The Commission report marks a vital call to action for the global health community and for governance bodies at the international, regional, national, and local levels. Combating childhood cancer is a morally imperative investment – and it is incumbent upon nations the world over, including India, to tackle inequities in access to care, medicines, diagnostics, and support in tandem to ensure that no child suffers or dies needlessly due to cancer simply by right of the size of their country’s economy.
“Sustainable care for children with cancer: a Lancet Oncology Commission” can be accessed here.