Global childhood cancer survival estimates and priority-setting: a simulation-based analysis

Abstract

Background: Accurate childhood cancer survival estimates are critical for policy-makers and clinicians for priority-setting and planning decisions. However, observed survival estimates are lacking for many countries, and where available, wide variation in outcomes is reported. Understanding the barriers to optimizing survival can help improve childhood cancer outcomes. We aimed to provide estimates of global childhood cancer survival, accounting for the impact of multiple factors that influence cancer outcomes. Methods: We developed a microsimulation model to simulate childhood cancer survival for 200 countries/territories worldwide, taking into account clinical and epidemiologic factors, including country-specific treatment variables, such as availability of chemotherapy/radiation/surgery. To ensure model results were consistent with reported survival data, we calibrated the model to estimates from the CONCORD 2 and 3 studies using an Approximate Bayesian Computation approach. We estimated five-year net survival for diagnosed childhood cancer cases in each country/territory and estimated potential survival gains if seven policy interventions focused on improving treatment availability and delivery were implemented in isolation or as packages. Findings: Our model estimates that global five-year net childhood cancer survival is currently 37•4% (95% uncertainty interval [UI] 34•7%-39•8%), with large variation by region, ranging from 8•1% (95% UI 4•4%-13•7%) in Eastern Africa to 83•0% (95% UI 81•6%-84•4%) in North America. Among the seven policy interventions modeled, each individually provided limited gains, increasing global five-year net survival to between 38•4% and 44•6%. When bundled into packages of interventions that either improved service delivery or expanded treatment access, five-year net survival increased to 50•2% (95% UI 47•3%-53•0%) and 54•1% (95% UI 50•1%-58•5%), respectively. A comprehensive systems approach consisting of all policy interventions yielded super-additive gains with global five-year net survival of 53•6% (95% UI 51•5%-55•6%) at 50% scale-up and 80•8% (95% UI 79•5%-82•1%) at full implementation. Interpretation: Childhood cancer survival varies widely by region, with especially poor survival in Africa. While expanding access to treatment (chemotherapy/radiation/surgery) and addressing financial toxicity are essential, investments that improve the quality of care, at both the health system and facility-level, are needed to improve childhood cancer outcomes globally.

What are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in Thailand? Development and application of an estimation tool

“…GCC 5-year survival rates are projected to improve from 37% to ≥50% with expanded treatment access or improved service delivery and to 42% with improved access to chemotherapy only. 13 Equitable access to appropriate medicines is thus a necessary but not sufficient component of a health system equipped to treat children with cancers.…”

“…18–20 Paediatric cancer registries are in place across the country and regular analyses of incidence and survival have been published over time. 18–22 At 67%, 5-year net survival of children with acute lymphoblastic leukaemia (ALL) (the most common form of cancer in children in most regions of the world) in Thailand is higher than the global (56%), Asian (53%), South-Eastern Asian (40%) and the upper middle-income countries averages (63%) but lower than survival in high-income countries (88% on average) 13 (see online supplemental table 1 for more indicators).…”

Particular Qualities of Organizing Teaching Parents to Care a Child With Oncological and Oncomematological Pathology: Recommendations for Oncologists and Family Physicians

“…Протягом останніх десятиріч діагностики та лікувальний алгоритм онкологічних та онкогематологічних хвороб у дітей значно поліпшилася завдяки багатьом медичним дослідженням та отриманим досягненням в сфері онкології, гематології та імунології. Як наслідок -прогноз у разі наявності онкологічної патології поліпшився і наразі близько 60 -80 % дітей з онкологічним діагнозом досягають зрілого віку [1,2]. Діти з онкологічними та онко-гематологічними захворюваннями отримують лікування в спеціалізованих стаціонарах, а відсутність адекватного навчання членів родини пацієнта або самого пацієнта відносно навичок догляду та контролю за ними мо-же негативно вплинути на перебіг захворювання та результати лікування.…”

Interventions to improve early detection of childhood cancer in low‐ and middle‐income countries: A systematic review

“…6 Emerging evidence suggests that this survival gap can be diminished through both targeted childhood cancer program development and broader health system strengthening. [7][8][9] Moreover, current evidence indicates that childhood cancer treatment in LMIC settings is cost-effective. [10][11][12] Improved childhood cancer outcomes in LMICs will require overcoming multiple barriers that presently compromise care delivery and impact survival.…”

“…[10][11][12] Improved childhood cancer outcomes in LMICs will require overcoming multiple barriers that presently compromise care delivery and impact survival. [7][8][9]13 As modifiable risk factors for childhood cancer are unknown, efforts to increase timely diagnosis and access to effective treatment are crucial. A lack of both professional and public awareness of the early warning signs and symptoms (EWSS) of childhood cancer is a fundamental barrier in many LMICs.…”