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    Small investment could boost pediatric cancer survivorship in poorer nations

    Raul C. Ribeiro, MD

    A small hike in funding for pediatric cancer care could significantly boost survival rates in low- and middle-income nations, according to an international team lead by St. Jude.

    Research analyzed data from 10 such nations and found no correlation between a country’s pediatric cancer survivor rate and its overall mortality rate for children under age 5.

    International agencies consider under-5 mortality as an important indicator of child health within a nation. However, the study concluded that pediatric cancers are not a factor in the under-5 mortality because they are uncommon and often underdiagnosed.

    “This is a call to the global community that it is possible to increase pediatric cancer survival, even in countries that have high under-5 mortality rates for other causes, such as infectious diseases,” said Raul Ribeiro, MD, International Outreach Program director and the paper’s first author. “With a modest financial investment, we can improve survival very quickly.”

    Ribeiro and his colleagues reported their analysis of the data in the August issue of The Lancet Oncology, which is devoted to global health issues.

    Physicians worldwide diagnose some 160,000 new cancers each year in children younger than age 15. As a group, pediatric cancers are curable, with an 80 percent five-year survival rate in the United States and Western Europe. In developing countries, however, the five-year survival rate often falls below 20 percent.

    The World Health Organization and other global health agencies have no programs to correct this disparity, largely because of the belief that it would take staggering amounts of money.

    However, results from the two-decades-old St. Jude International Outreach Program have indicated otherwise. St. Jude now has “twinning” partnerships in 16 low- and mid-income nations, in which the hospital joins with medical institutions to improve pediatric cancer outcomes.

    The new study was conducted as part of My Child Matters, an international program that seeks to jump-start a significant decrease in pediatric cancer deaths.

    Sanofi-aventis Humanitarian Sponsorship Department and the International Union Against Cancer originated the program in 2005 in collaboration with several health groups, including St. Jude, the National Cancer Institute, the International Society of Pediatric Oncology and the International Agency for Research on Cancer.

    The 10-country study sought to determine the baseline level of pediatric cancer care in the first nations to receive My Child Matters grants—Bangladesh, Egypt, Honduras, Morocco, Philippines, Senegal, Tanzania, Ukraine, Venezuela and Vietnam.

    A seven-member team from the Paris-based public-health firm Sanisphere conducted field interviews with clinicians, hospital managers, health officials and other knowledgeable individuals.

    A key discovery was that although under-5 mortality has decreased substantially in some underdeveloped countries, such as Vietnam and the Philippines, the rate of pediatric cancer deaths has not (postulated five-year survival rates were 5 percent and 10 percent, respectively).

    In other countries with similar or greater under-5 mortality, survival among pediatric cancer patients has significantly increased. These included Morocco, Honduras and Venezuela (postulated five-year survival rates were 30 percent, 40 percent and 60 percent, respectively).

    “That is because these countries have developed twinning programs with St. Jude and other institutions,” Ribeiro said.

    Among the study’s other findings:

    “The data show a modest investment in health, if it is well organized, can produce an incredible increase in pediatric cancer survival,” Ribeiro said.

    Achieving this goal requires that a nation recognize its deficiencies in pediatric cancer care and make correcting those inefficiencies a high priority. The nation can then partner with an outside organization, such as St. Jude, to create or focus on a single pediatric cancer unit and make it the nucleus for training, education and grass-roots community participation.

    From that unit, pediatric cancer care can expand to a second unit, then a third and so on. In similar fashion, a pediatric cancer registry started at one unit can seed other registries, and eventually a national registry.

    “Countries with limited resources should not be afraid to tackle pediatric cancer as a national health priority because they can have decent programs if they make a relatively small investment,” Ribeiro said. “And that investment can come from outside sources as well.”

    This work was supported in part by a grant from the National Institutes of Health, by the Sanofi-aventis Humanitarian Department and by ALSAC.

    August 2008