Closing the cancer gap: why addressing childhood cancer inequality is a global priority

Cancer is typically known as an age-related disease due to the large proportion of cases in adults compared to children. Nonetheless, this places a great burden on the healthcare system worldwide as approximately 300,000 new cases of childhood cancer are reported every year with 1,900 cases diagnosed in the UK alone (Jenkins, H. 2021). Following the recent technological advancements, the survival rate has increased to 82% in England and Wales, however there is a prominent issue that needs to be addressed. The survival rate of childhood cancer in low-to-middle-income countries (LMICs) is as low as 10% and as a consequence, the child mortality rate is increasing. Many young children and teenagers in developing countries are dying from cancer, some without any pain relief, when this could be easily treated or managed if early intervention was accessible. The advancements in technology and medicine in high-income countries cannot truly be measured as a success if it cannot be translated to LMICS. This concern should be raised as a global priority to close the gap, if we are truly to beat cancer and reduce child cancer mortality.

There are global inequalities involving access to healthcare that contribute to the varying survival rates of cancer between countries, meaning that this affects the availability and efficacy of diagnosis and treatment to ensure that children can overcome the disease. The key issues contributing to this is a lack of awareness to spot early signs of development or misdiagnosis, even when children are correctly diagnosed, there are major difficulties with sufficient funding for treatment. A study conducted by Ward et al (2019) created a model and predicted that there will be 6.7 million cases of childhood cancer between 2015 to 2030. 43% of these will be undiagnosed with the majority of the cases deriving from Western Africa and South Asia based on the performance of the current health care system (figure 1).

Figure 1; Statistical data shows that half of childhood cancer cases are missed and the magnitude of the issue roots from low-middle income countries.

Drew, K and Sternberg, S. 2019.

Cancer has been found to be misdiagnosed as tuberculosis, which is the tip of the iceberg for the plethora of unresolved issues in LMICs. Time spent trying to treat and alleviate the symptoms of what is thought to be tuberculosis is increased time for the tumours to metastasise and the condition of the child worsens. The issue with underdiagnosis and underreporting could be addressed if the general knowledge of the disease was improved. One simple but effective approach would be to promote cancer-awareness campaigns and educating staff on the consequences of misdiagnoses; in addition, sufficient funding could provide screening programmes similar to that in high-income countries (Hannan, 2016).

Even when children are correctly diagnosed with cancer, the majority of patients have limited access to adequate treatment and families struggle to pay for whatever is available. As a consequence, this leads to many children being abandoned or refused for treatment which has been reported to occur 20–30% of the time in the Philippines compared to a mere 5% in Colombia (Eden et al, 2019). The families who are fortunate to be able to be offered treatment for their children have additional burden to bear; with having to work extra hours and travelling great distances to hospitals that could be in the next town or city over, this pushes many further into poverty. The work of Moye-Holz et al (2020) conducted the first study to provide insight into the availability and affordability for diagnosis and treatment of cancer in Mexico. Out of 49 medications, only 7 from the public sector and 5 in the private sector were classified as affordable; the availability of the treatment fell below the target set by the World Health Organisation (WHO) of 80%. However, at the time of the study, many medications were out-of-stock whilst the information of others were restricted; and so, this did not truly capture the actual availability, which emphasises the need for future research. Nonetheless, this demonstrates why a substantial proportion of the global burden of childhood cancer stems from LMICs at 82.2% measured by disability-adjusted life years (Force et al, 2017).

The WHO are aiming to increase the survival rate for childhood cancer to 60% by 2030, with future prospects to make therapeutic intervention and early diagnosis more accessible and cost-effective (World Health Organisation, 2018). Beating cancer cannot solely be achieved by the emergence of new medicines; ensuring appropriate systems, services and support for childhood cancer should be a shared priority for the betterment of all. Once we recognise the gap and address global inequality, only then will we make real progress against cancer.

References

Drew, K and Sternberg, S. 2019. Global Diagnosis Gap: Half of Childhood Cancer Cases Are Missed. [Online]. Available from: https://www.usnews.com/news/best-countries/articles/2019-09-05/the-global-effort-to-find-and-treat-children-with-cancer

Eden, T., Burns, E., Freccero, P., Renner, L., Paintsil, V., Dolendo, M., Scalan, T., Khaing, A.A., Pina, M., Islam, A., Chunda-Liyoka, C., Kouya, F. and Molyneux, E. 2019. Are essential medicines available, reliable and affordable in low-middle income countries? Journal of Cancer Policy. 19(3), [no pagination].

Force, L.M., Abdollahpour, I., Advani, S.M., Agius, D., Ahmadian, E., Alahdab, F., Alam, T., Alebel, A., Alipour, V., Allen, C.A., Almasi-Hashiani, A., Alvarez, E.M., Amini, S., Amoako, Y.A., Anber, N.H., Arabloo, J., Artaman, A., Atique, S., Awasthi, A. and Bagherzadeh, M. 2019. The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017. The Lancet Oncology. 20(9), pp.1211–1225.

Fung, A., Horton, S., Zabih, V., Denburg, A. and Gupta, S. 2019. Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review. BMJ Global Health. 4(5), pp. 1–13.

Hannan, A. 2016. Misdiagnosis of Cancer as Tuberculosis in Low-to-Middle-Income Countries: A Tip of the Iceberg! Journal of Global Oncology. 2(4), pp. 244–245.

Jenkins, H., 2021. Children’s cancers incidence statistics. [online] Cancer Research UK. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/childrens-cancers/incidence#heading-One[Accessed 6 February 2021].

Moye-Holz, D., Ewen, M., Dreser, A., Bautista-Arredondo, S., Soria-Saucedo, R., van Dijk, J., Reijneveld, S. and Hogerzeil, H., 2020. Availability, prices, and affordability of selected essential cancer medicines in a middle-income country — the case of Mexico. BMC Health Services Research, 20(1), pp.1–11.

Ward, Z., Yeh, J., Bhakta, N., Frazier, A. and Atun, R., 2019. Estimating the total incidence of global childhood cancer: a simulation-based analysis. The Lancet Oncology, 20(4), pp.483–493.

World Health Organisation. 2018. Global Initiative for Childhood Cancer. 4 October. News. [Online]. [Accessed 27 February 2021]. Available from: https://www.who.int/news/item/04-10-2018-global-initiative-for-childhood-cancer