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Meeting the challenge of child cancer in the developing world
February 19, 2014
   
   

In its 2013 Seasonal Appeal, the Financial Times partnered with World Child Cancer to support pediatric cancer wards in low- and medium-income countries (LMICs) through twinning partnerships with high income countriesaEUR(TM) oncology centers. WCC has saved an estimated 5,500 children and trained more than 800 health-care providers in those nations. This video shows how these partnerships are making a crucial difference in the lives of children living with cancer.

Globally, more than 200,000 children and adolescents are diagnosed with cancer every year. Eighty percent of them live in LMICs, and they account for more than 90 percent of cancer deaths. The number of children with cancer is expected to increase 30 percent by 2020 (taking into account current population growth and infant mortality rates). To fight this scourge, however, LMICs have less than 5 percent of the global resources used to prevent, cure or palliate the disease.

To help a child with cancer in a resource-poor country presents formidable global challenges. Late presentation and underdiagnosis are common and lead to disastrous consequences. For example, of the 8,000 children diagnosed yearly with retinoblastoma (a malignant tumor of the eye), 66 percent live in LMICs. Their prognosis is poor because with retinoblastoma, early diagnosis and treatment are crucial.

Refusal and abandonment of therapy affect 50 percent to 60 percent of children in LMICs and are a major cause of therapeutic failure. Health care providersaEUR(TM) ability to communicate effectively with a patientaEUR(TM)s parents is key to encouraging participation in and adherence to therapy. Of course itaEUR(TM)s also essential that the supply chain of cancer medicines be uninterrupted and affordable.

In children with cancer in the LMICs, the prevalence of malnutrition may be as high as 70 percent. Malnutrition decreases plasma protein, allowing higher toxicity rates from chemotherapy (notably neutropenia), infections and subsequently decreased survival rates.

Supportive care (curative treatment) is limited by the high incidence of nosocomial infections due to poor hand hygiene. Many hospitals do not have adequate water supply and infrastructure, so alcohol gel hand hygiene is recommended by the World Health Organization to reduce infection rates. Successful cancer care requires the availability of safe blood products. Only 13 LMICs have a national hemovigilance system to ensure the safety of the transfusion process, and only 53 percent of blood donations are screened for safety.

Palliative, or end-of-life, care programs are cruelly inadequate in the LMICs. Pain management initiatives may be available in less than 50 percent of pediatric oncology units. Virtually all opiate analgesics are consumed in high income countries. Skilled professional nurses trained in oncology are essential to successful cancer treatment. Challenges to the education and retention of oncology nurses in LMICs include lack of access to training programs and inadequate financial support for training and salaries.

What to do with so many needs and so few resources? At the macroeconomic level, increasing annual government health-care expenditure per capita was significantly correlated with postulated survival in patients under 5 years of age in a sample of 10 LMICs (rA?=0A?882; p<0A?0001); see the chart below. We find it promising that treating one cancer is also relatively affordable. Burkitt’s lymphoma is the most common pediatric cancer, responsible for 50 percent of cancer deaths of children living in East African countries such as Uganda, Kenya and Tanzania. BurkittaEUR(TM)s lymphoma causes massive tumors that deform necks, faces and bellies. Fortunately, this cancer is treatable, with a remission rate as high as 95 percent. More than 85 percent of these children could be treated for less than US $600 a case.

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Source: Adapted from Ribeiro et al. “Baseline status of pediatric oncology in ten low-income or mid-income countries receiving My Child Matters support: a descriptive study” (2008). Lancet Oncol 2008; 9: pp. 721-729