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June 17, 2014

SickKids expert leads editorial calling for paediatric cancer to be made a global child health priority

Childhood cancer is a difficult subject to tackle, but one expert from The Hospital for Sick Children (SickKids) is calling for integrated national strategies for better paediatric cancer care. While the last decades have witnessed tremendous advances in cure rates for childhood cancer, these improvements have not translated to low and middle income countries. Cancer now represents the leading cause of non-accidental death among children in a growing number of middle income countries. Of the 175,000 children diagnosed with cancer every year, an estimated 150,000 live in low and middle income countries, although this figure is likely to be a sever underestimate given endemic issues of under-diagnosis and under-registration. 

A new policy editorial published June 17 by PLOS Medicine argues that paediatric cancer should now be considered a global child health priority and calls for the development and implementation of comprehensive national childhood cancer strategies, in order to reduce global childhood cancer mortality and optimize outcomes for children living with cancer in resource-poor environments.  

The editorial, led by Dr. Sumit Gupta, Staff Oncologist at SickKids, and experts from the Mexican National Institute of Pediatrics and St. Jude Children’s Research Hospital, TN, USA, recommends the development of integrated national strategies incorporating national care standards, accreditation of childhood cancer centres, establishment of national childhood cancer governing bodies and the introduction of mandatory reporting through the set-up of national paediatric oncology registries.

The authors acknowledge the many challenges faced by low and middle-income countries to addressing childhood cancer mortality, including resource constraints, deficits in infrastructure, and gaps in policy evaluation and analysis. However, with support from the global health community, efforts by low and middle-income countries to create national childhood cancer strategies can be set up for success.

Analogous to past thinking around childhood HIV, the authors state that today, many policymakers believe that childhood cancer treatment is far too complex and costly for most low-and middle-income countries.  The authors argue that like childhood HIV, such treatment is feasible, and that similar achievements in care are possible for children with cancer in these countries.

“Twenty-five years ago, many people thought that treating HIV in developing countries would never work; it was too expensive and complicated,” says Dr. Gupta. “ Today, we are facing a similar mindset with childhood cancer.   With a commitment to addressing this significant pediatric health problem, evidence suggests that national strategies could lead to improved outcomes for children with cancer around the world.”

Dr. Gupta sits on the Executive Committee of the SickKids-Caribbean Initiative (SCI) a not-for-profit collaboration between SickKids and seven Caribbean institutions across six countries that strive to improve the outcomes and quality of life for children with cancer and blood disorders. The partners are working together to develop a comprehensive strategies to strengthen the diagnosis and treatment of children with cancer and blood disorders in the Caribbean.

Dr. Gupta is Co-Lead of SCI’s Oncology Databases Working Group - establishing local hospital-based oncology databases for ongoing prospective data collection, allowing for the evaluation of implemented changes in therapy or supportive care. This treatment and outcome data from participating institutions will help to improve the clinical management of children in participating countries and the evidence collected will inform the development and implementation of interventional studies aimed at improving the delivery of care and outcomes for children.