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Cancer in Children; The Global Scene

Cancer in Children; The Global Scene. Ian Magrath. www.inctr.org. Relative 5 yr Survival Rates (SEER) All Sites, M and F. Percent. Five Year Survival Rates (SEER) 1992-8, 0-14 years. Percent. Pediatric Cancer as a Cause of Death.

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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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