Cancer in Children; The Global Scene

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

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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

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Cancer in 0-14 yr Olds as a Percentage of All
Cancer
Globocan 2002
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Global Childhood Cancer Burden
0-14 yrs 15-19 yrs 0-19 yrs
Less Developed 133 931 46 538 180 469
More Developed 26 964 8 907 35 871
World 160 882 55 445 216 327
Estimate for 15-19 is 25-33 of cancer 0-19
Globocan 2002
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Global Childhood Cancer Burden
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Ratio of Deaths to Cases (0-14 years)
Deaths Cases Ratio
More Developed 6 893 26 864 0.256
Less Developed 80 116 133 931 0.598
NB. Data extrapolated from the few existing
registries nearly all in urban regions the
true situation is probably significantly worse
Globocan 2002
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Annual Deaths versus Cases
NB. Data extrapolated from existing registries
the true situation is probably significantly worse
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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

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Frequencies ()
USA-W Brazil Uganda Zimbabwe
Leukemias 31 28 6 21
Lymphomas 10 21 29 11
CNS 21 13 1 11
Sympathetic 9 2 1 4
Retinoblastoma 3 8 6 9
Renal 7 9 4 15
Hepatic 2 0 1 2
Bone 4 6 3 4
Soft Tissue 7 4 41 18
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USA Whites 83-92 (0-14 yrs)
ALL 31 NHL 10 CNS 21
14 per 100K
Data from IARC IICC 1998
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Uganda 92-95 (0-14 yrs)
gt66 KS or BL
KS
18 per 100K
Data from IARC IICC 1998
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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

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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

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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

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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

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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

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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
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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