More than 11 million healthy childhood life years are lost to treatment-related ill-health and disability and fatal cancer, according to the Global Burden of Disease Study (GBD) to assess childhood and adolescent cancer burden in 195 countries in 2017 published on 29 July in the Lancet Oncology (1). Childhood cancer, in particular, is a major contributor — among the top four — to the global disease burden. Moreover, the study reveals massive inequities in childhood cancer burden between high and low-income countries.
The findings are based on so-called disability-adjusted life years (DALYs), a measure commonly used to evaluate disease burden where one DALY is equivalent to one year of healthy life lost. Although, the authors say this is probably underestimated since the assessment only includes disability in the first 10 years after a cancer diagnosis rather than the entire lifespan of the child.
Nonetheless, the findings are an important first step in establishing the role of childhood or paediatric cancer in frameworks addressing global oncology and global child health, says lead author Dr Lisa Force of the St Jude Children’s Research Hospital in the US. And the first to provide a complete picture of the global and regional burden of childhood cancer that goes beyond incidence, mortality, and survival – the use of DALYs provides a more comprehensive understanding of the devastating impact of cancer on children globally.
Countries with the highest childhood cancer burden were in Asia and Oceania — including India, China, Pakistan, and Indonesia — followed by the US. However, the biggest DALY burden for paediatric cancer types was in sub-Saharan Africa.
The study also showed the burden is disproportionally high in the poorest of nations, which account for over 82 per cent of the global childhood cancer burden — equating to around 9.5 million years of healthy life lost in 2017. Whereas survival rates for paediatric cancers are much higher in high-income countries — around 80 per cent — sadly the same healthcare improvements have not yet reached low- and middle-income countries, where survival rates are as low as 20 per cent.
“Estimating the years of healthy life children have lost due to cancer allows policymakers to compare the lifelong implications of childhood cancer with other diseases, potentially helping them determine the most effective way to spend limited resources and identify high-impact cancer-control planning decisions”, Force explains.
Furthermore, the authors suggest the new data are crucial for effective resource planning and prioritising health policies, which they say is required for “well-functioning health systems”. This could potentially prevent the unnecessary loss of childhood life years by ensuring early diagnosis and treatment of cancers as well as other devastating diseases.
However, the researchers also point out that the same screening strategies used for adults are not as useful for paediatric cancers, as they typically progress much more quickly and without rapid diagnosis and treatment, can be fatal. Moreover, high-quality paediatric cancer data is still lacking, particularly in developing countries. Therefore, improved reporting systems and indeed, big data approaches will be crucial for significantly reducing the global burden of childhood cancer.
(1) GBD 2017 Childhood Cancer Collaborators. The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017. The Lancet Oncology (2019). DOI: 10.1016/S1470-2045(19)30339-0