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When childhood cancer is diagnosed early and treated effectively, the survival rate is impressive. In the US, for example, the five-year survival rate for children with cancer is 80 percent.
"Survival rates are much lower in many regions of the world," says Lisa Force, a pediatric oncologist at St. Jude Children's Research Hospital and author of a new report in The Lancet Oncology in calculates the number of healthy life years lost in childhood cancer in 2017.
Amazing Number: 11 Million Years Lost Cancer-related mortality and the complications that children have even if they survive cancer – when you're done with the treatment, there's a high risk of nerve damage and chronic diseases like heart failure.
And of the 400,000 cases of childhood cancer diagnosed each year, 140,000 die.
Yet in many poor and low-income countries, there is not even a national policy that sets out how to fight childhood cancer, Force said. Developing this policy is a goal of the World Health Organization and St. Jude Children's Hospital, which have joined forces to achieve the United Nations-mandated goal of reducing the survival of childhood cancer to 60 by 2030 Improving Percentage for the Six Most Important Cancers in Children Worldwide Currently, the mortality rate in low- and middle-income countries is reportedly averaging 37 percent and possibly just 20 percent, says a St Jude spokesman.
We talked to Force about the report. This interview was revised for reasons of length and clarity.
How can you obtain data on cancer in children if no cases and deaths are registered in some countries?
We begin with the number of deaths from cancer detected in systems around the world, from verbal autopsies and from cancer registration systems that often detect cases or diagnoses. In order to estimate in areas where we have no data, we will essentially borrow information from the surrounding areas or regions.
To reduce the number of years lost to death and other illnesses, you need a quick diagnosis. Why is that?
Childhood cancers generally develop quite rapidly. In most cases, they are known to be fatal without rapid diagnosis and treatment. To improve the survival of childhood cancer, well-functioning health systems are needed.
Are early diagnoses possible in low- and middle-income countries?
A challenge. You may not have a hospital near you. Or even if you have a clinic and a parent gives birth to a child, the symptoms may be similar to other illnesses – swelling of the lymph nodes may be thought of as something like TB; or in leukemia, multiple blood cells have failed, which may be mistaken for malaria.
Diseases such as tuberculosis, malaria and HIV cause many deaths in children and adults in developing countries. Is it more important to provide funds for these diseases than for childhood cancer?
We certainly do not say that childhood cancer is more important than any other disease. More than that, cancer has not been discussed when policymakers create frameworks that address children's diseases. Cancer is often not even brought to the table as a factor to consider. Or, in developing a national cancer control program, many governments do not include children in these plans at all. We also know that in many of these scenarios, the burden of infectious diseases decreases over time, the better the countries treat them, and the burden on non-communicable diseases, such as cancer, increases accordingly.
What is a first step? Can a country act against childhood cancer?
The first step is to find out what your country is currently doing to fight childhood cancer and what its needs are.
And what kind of programs would be helpful?
A convenient referral route, educating the frontline providers to know which symptoms to look for, labs to help you with the early detection of cancer, and effective treatment – chemo and radiation and surgery.
What role can parents play?
I do not want to frighten everyone and think that everyone is suffering from cancer. But I would just say in general terms that there are signs to watch out for – persistent fever, weight loss, night sweats, tiredness, extra bleeding, a mass that shows up externally or internally. And if something does not feel right with your children, if you seek medical help, and if you do not feel that someone is listening to you properly, I recommend that you be the best advocate for your child that you can be to seek different opinions and to go back a provider.
One of the messages I receive from your report and comments is that children with cancer are in some ways invisible in many countries.
Exactly. I hope this report emphasizes that children worldwide develop cancer, whether or not there is a cancer registry [keeping track of cases in a country]. These children are vulnerable and neglected in cancer-related policies. As a global community, we need to improve its involvement in our framework to improve our health systems. The tragic thing is that cancers in high-income countries are very curable and the survival rate is much lower in many parts of the world. Unfortunately, at the moment it is an important prognostic indicator of the survival of the child's place of residence.