Wednesday 29 February 2012

Why should there be a focus on children with cancer in resource-limited countries?

This is an often asked question in the context of much of the developing world. And the question should not be surprising; after all neonatal and child mortality from inadequate perinatal care and infectious diseases continue to be the main challenges in these settings. When resources are limited, and needs are many, then often the "less deserving" miss out. Over 5000 children die in India EVERY DAY before they reach the age of 5 years, most of them from prematurity and low birthweight ; neonatal infections; birth asphyxia and birth trauma; pneumonia; and diarrhoeal diseases. In comparison, the total number of children less than 15 years of age with cancer EVERY YEAR in India is around 50,000. So it is not difficult to do the maths and work our areas of focus.

Nevertheless, the life of every child is important and those of us involved in looking after children with cancer in resource-limited settings are well aware of the challenges of access to care, treatment abandonment, etc. The recently published report of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries titled "Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries" is an essential read for all the stakeholders involved in delivering care to children with cancer in developing countries. The global task force is composed of leaders from the cancer and global health communities and is an initiative convened by Harvard Global Equity Initiative, The Harvard Medical School, The Harvard School Of Public Health And The Dana-Farber Cancer Institute.

The report highlights some very important facts which I think are relevant for us

  1. More than 85% of all newly diagnosed children with cancer and 95% of deaths in children with cancer occur in low and middle income countries.
  2. For children aged 5-14, cancer is the third leading cause of death
    in upper-middle, fourth in lower-middle, and eighth in low income countries.
  3. A child diagnosed with cancer who lives in one of the poorest countries has an 80% probability of dying, compared to less than 30% in one of the wealthiest countries

The report identifies a set of candidate cancers and compelling  Cancer Care and Control   opportunities for immediate action to expand prevention and/or treatment. Among these are cancers in children which are ideal targets for advocacy and action in low and middle income countries.