Bridging the gap in childhood cancer care: a call to action on World Cancer Day
Introduction
On 4 February every year, we commemorate World Cancer Day, a day set aside for global advocacy for collective action against cancer. With the theme “Close the Care Gap”, this post highlights a category of cancers that has been neglected, even though they tend to respond better to chemotherapy and most often have better prognoses. Interestingly, this category of cancers affects a demographic that we often refer to as the leaders of tomorrow: children. I am talking about childhood cancers. Childhood cancers, especially in the Global South, have been neglected for reasons such as higher mortality rates from infectious diseases, compounded by factors like insufficiently trained medical professionals, inadequate diagnostic resources, and limited access to both therapeutic and palliative care. However, one can argue that the actual prevalence of childhood cancer remains largely unknown in the Global South, where reliable cancer registries are almost non-existent.
Challenges
Cancer is one of the leading causes of death among children and adolescents aged 0-19 with as much as 90% of these deaths occurring in the Global South, especially in Africa. (WHO, 2021) Children who have cancer in countries in these regions, such as Nigeria, have significantly lower survival rates (20–30%) than their counterparts in the Global North (80–90%), like Canada. (WHO, 2021)
The disparity in survival and outcomes is caused and perpetuated by issues such as poor access to childhood cancer medicines and unaffordable care, which is exacerbated by out-of-pocket expenses for healthcare. Furthermore, in countries like Nigeria, available evidence suggests that cancer control plans and essential medicines lists do not prioritize childhood cancer treatment. (Nigeria Cancer Control Plan 2018 – 2022) There is also the issue of low-quality healthcare systems, which, according to the Lancet Commission report on high quality healthcare systems, (Kruk et al, 2018) little is known about the quality of care for cancer. This suggests that the delivery of cancer care, the trust patients have on the delivery of this care, and the adaptability of this care to complex and changing healthcare landscapes is suboptimal, at best.
Strategies
While wide, systemic, and structural changes are required to build high-quality health systems for diseases like childhood cancer, there are low hanging strategies that can be implemented to reduce childhood cancer burden and mortality. One of these strategies is the improvement of access to childhood cancer medicines. Evidence suggests that this strategy is highly feasible and cost-effective and can improve survival. (WHO, 2020) However, only 29% of countries in the Global South report general availability of childhood cancer medicines, compared to 96% of Global North countries. (WHO, 2021)
Thankfully, the World Health Organization (WHO), seems to agree with this strategy and announced a partnership with St. Jude Children’s Research Hospital in the United States to launch the Global Platform for Access to Childhood Cancer Medicines in 2021. (WHO, 2021) This platform is a USD 200 million investment over six years which is envisioned to provide a continuous supply of quality childhood cancer medicines in the Global South. However, much movement regarding the implementation of this platform is yet to be seen, at least from an outsider's perspective, despite the lofty goals of this platform to improve access to life-saving medicines for children who are suffering and dying daily.
While launching platforms like this is vital, quickly setting it up and implementing it is crucial to curbing this disease. What is also crucial is to consider other aspects of cancer care and if possible, the entire cancer care continuum from health promotion and early detection to treatment, palliative care, and survivorship. Without delving deeper into the entire continuum, an example can be made from one of the components: early detection. Detecting these cancers early improves prognosis and survival. For children with cancer, early detection is key as the timeline to detection could even be worse because, depending on the age of the child, they may not be able to articulate what exactly is wrong with them. And because these cancers have symptoms similar to other illnesses, they may not be the first thing to suspect by a parent to start with, and even a doctor at the primary care level. For instance, in Nigeria, where malaria is endemic, a child that could be having a form of cancer could keep receiving repeated treatments for malaria with different antimalarial medicines simply because the symptoms are similar, meanwhile, the cancer is growing and possibly spreading. This could worsen the time to detection and proper treatment.
Call to Action
Governments should implement appropriate health reforms to help address the systemic structures that continue to perpetuate the neglect of childhood cancers, such as increasing funding for cancer research in addition to developing and implementing national cancer strategies and disease registries. This should be accompanied by including childhood cancer medicines into essential medicines lists, ensuring a comprehensive benefit package for childhood cancers, and regulating products and activities that are carcinogenic to children, including ultra processed foods. Furthermore, a more comprehensive health systems strategy and commitment to address wider social determinants of health that impede access to care, such as empowering people and communities, and strengthening primary healthcare, are needed.
Most importantly, early career researchers can contribute to building evidence required to support interventions for childhood cancers, [...], such as those that are implementation science based...
Civil society and the public can push for advocacy for all concerned stakeholders to act decisively and quickly. They can support initiatives aimed at health promotion and improving education and health literacy around childhood cancers. They can also actively support developing and disseminating materials that are culturally appropriate and useful in improving communication with patients and their families.
Most importantly, early career researchers can contribute to building evidence required to support interventions for childhood cancers, including filling some of the research gaps identified in the Lancet Commission on high-quality healthcare systems, such as those that are implementation science based and that build national and regional capacity in improving childhood cancer services along the entire continuum of care.
Conclusion
In summary, addressing childhood cancer, particularly in the Global South, requires urgent, multi-faceted interventions. Governments need to integrate childhood cancer into national health strategies, develop accurate disease registries, and ensure the availability of essential cancer medicines. Broader societal efforts are essential, including robust advocacy, health literacy promotion, and community empowerment. Furthermore, early career researchers play a critical role in filling research gaps and building evidence for effective interventions. The collective effort to implement WHO's Global Platform for Access to Childhood Cancer Medicines and a comprehensive focus on the cancer care continuum is vital. This approach is not only a moral imperative but a crucial step towards equitable cancer care for children worldwide. These actions should be quick because even though childhood cancers are one of the "easiest" cancers to treat and have very good prognoses and survival rates, children with this disease in the Global South continue to lose their lives. Indeed, if these children are the leaders of tomorrow, then we need to give millions of them a fighting chance, a chance at life, a chance to lead our world tomorrow.
Our time to act is now!
References
World Health Organization (WHO) (2021). Childhood cancer. Available at: https://www.who.int/news-room/fact-sheets/detail/cancer-in-children [Accessed 15 January 2024]
Nigeria Cancer Control Plan 2018 - 2022. Available at https://www.iccp-portal.org/system/files/plans/NCCP_Final%20%5b1%5d.pdf [Accessed 15 January 2024]
Kruk ME, Gage AD, Arsenault C, et al. (2018). High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018 Nov;6(11):e1196-e1252. doi: 10.1016/S2214-109X(18)30386-3.
WHO. (2020). Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2019 global survey. Geneva: World Health Organization; 2020
WHO. (2021). WHO and St. Jude to dramatically increase global access to childhood cancer medicines. Available at https://www.who.int/news/item/13-12-2021-who-and-st.-jude-to-dramatically-increase-global-access-to-childhood-cancer-medicines [Accessed 15 January 2024]
Otuto Amarauche Chukwu is a doctoral researcher in Health Policy at the Institute of Health Policy, Management and Evaluation, University of Toronto. A Nigerian, he is a licensed pharmacist and multiple award-winning scholar and Social Impact Innovator with over a decade’s experience in health systems strengthening and policy research in sub-Saharan Africa. His PhD research is on cancer control policy where he is specifically exploring strategies to expand access to cancer control services in low- and middle-income countries.
First image: Photo by National Cancer Institute on Unsplash
Second image: By the World Cancer Day website