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Cancer in Children; The Global Scene

Explore the global scenario of childhood cancer, the challenges faced in developing countries, and the importance of research. Find out about survival rates, patterns of childhood cancer, and strategies for improving care. Learn how poverty impacts treatment and access to care.

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Cancer in Children; The Global Scene

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  1. Cancer in Children; The Global Scene Ian Magrath www.inctr.org

  2. Relative 5 yr Survival Rates (SEER) All Sites, M and F Percent

  3. Five Year Survival Rates (SEER) 1992-8, 0-14 years Percent

  4. Pediatric Cancer as a Cause of Death • In western countries, cancer is the number one cause of disease-related death in children • In developing countries, its rank order varies with socioeconomic status, but it is often the first cause of disease-related death in 5-14 year-olds and 15 to 24 year-olds

  5. Relative Importance of Childhood Cancer • The incidence of cancer (0-14 yrs) is lower in less (9.6 and 7 per 100k in M and F) versus more developed (11.6 and 13.8) countries • In developing countries children comprise a higher fraction of the population (up to 50%) • 88% of children live in developing countries • 80% of all childhood cancer occurs in developing countries

  6. Cancer in 0-14 yr Olds as a Percentage of All Cancer Globocan 2002

  7. Global Childhood Cancer Burden Estimate for 15-19 is 25-33% of cancer 0-19 Globocan 2002

  8. Global Childhood Cancer Burden

  9. Ratio of Deaths to Cases (0-14 years) NB. Data extrapolated from the few existing registries – nearly all in urban regions: the true situation is probably significantly worse Globocan 2002

  10. Annual Deaths versus Cases NB. Data extrapolated from existing registries – the true situation is probably significantly worse

  11. Patterns of Childhood Cancer • 40-50% of all pediatric cancer in the world is leukemia or lymphoma – • treatment largely chemotherapy, but needs expertise and ALL therapy 2 years at least • Pattern of cancer particularly different in Sub-Saharan Africa – high incidence of KS and BL • KS largely HIV-related; preventable with HAART • Brain tumors more common in more developed countries – higher incidence than lymphomas • May be partly due to failure to recognize • Retinoblastoma also probably higher incidence but lack of rural data misleading

  12. Frequencies (%)

  13. USA Whites 83-92 (0-14 yrs) ALL 31% NHL 10% CNS 21% 14 per 100K Data from IARC IICC 1998

  14. Uganda 92-95 (0-14 yrs) >66% KS or BL KS 18 per 100K Data from IARC IICC 1998

  15. Impact of Poverty and Limited Resources • Inability to pay for care; lack of insurance in most low and middle income countries; drugs sometimes free • Illiteracy – lack of understanding of disease, care during chemotherapy and need for follow up; • poor hygiene increases toxicity of chemotherapy • Few specialist treatment facilities for childhood cancers –long journeys and lengthy stays at treating facility • Limited, if any, emergency care close to home

  16. Impact of Poverty and Limited Resources • Lack of health professionals, especially with knowledge of or expertise in childhood cancer (pathologists, oncologists, nurses, others) • Primary care physicians must consider diagnosis • Specialist surgeons needed for solid tumors- pediatric surgeons, ophthalmologists, orthopedic, neurosurgeons • Little time to talk to families • Lack of equipment (e.g., for radiotherapy), variable availability of drugs • Limited or inaccurate statistics and national planning

  17. Frequent Consequences • Late Presentation • Incorrect diagnosis • No or inadequate treatment • High toxic cost • Loss to follow-up • Low survival rates • No research • Limited or no palliative care

  18. The Need for National or Regional Research • Western clinical trials address western problems (e.g., limited study of advanced retinoblastoma and KS in childhood) • Western treatment protocols are designed in a western context (often complex, toxic and expensive) • Differences in disease biology, drug handling and co-morbidities occur in different ethnic groups and environments – treatment response may differ • Therapy is of higher quality in a research setting – discipline, data collection, audit

  19. INCTR Strategies • Conduct various projects in specific areas of cancer control (cancers in women and children highest priority) • Participating centers become training sites to improve regional and national coverage • Use multi-institutional clinical studies as a complete approach to training, education, research and patient care • Maximize use of IT in training, education, monitoring and measuring outcomes

  20. Childhood Cancer (INCTR) RETINOBLASTOMA Study of late diagnosis and treatment of extensive disease LEUKEMIA (ALL) Treatment; molecular profiling LYMPHOMA (AFRICAN BL) Treatment MY CHILD MATTERS Mentoring of projects in 5 countries Retinoblastoma Strategy Group Studies identified by disease specific strategy groups

  21. Conclusions • Major advances have been made in controlling childhood cancer (treatment) • Benefits are reaped predominantly by children with cancer in affluent nations • Lack of resources in developing world lead to many deaths in children with potentially curable cancer • More children could be cured globally by increasing the capacity for cancer treatment in developing countries

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