National childhood cancer strategies offer the best hope of improving outcomes in children with cancer living in resource-limited settings, according to experts from North America and Mexico writing in PLOS Medicine.
Dr. Sumit Gupta from The Hospital for Sick Children (SickKids) in Toronto, Canada, and colleagues argue that pediatric cancer should now be considered a global child health priority as cancer represents the leading cause of non-accidental death among children in a growing number of middle-income countries: world-wide, out of the 175,000 children diagnosed with cancer annually, an estimated 150,000 live in low- and middle-income countries, although this figure is likely to be a severe under-estimate.
The authors argue that reducing global childhood cancer mortality will require establishing national childhood cancer strategies, key components of which should include financial coverage, accreditation of childhood cancer centers, mandatory childhood cancer reporting and registration, development of national standards of care, and the creation of national childhood cancer governing bodies.
However, the authors acknowledge that there are many challenges to implementing these strategies, such as the limited implementation research, formal policy evaluation, and costing data. Furthermore, the ideal structure of such strategies in the lowest income countries is currently unknown, given severe resource constraints, deficits in infrastructure, and competing health needs.
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 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."