Despite impressive progress in treatment over the past half-century, childhood cancer still poses a major global health scourge in terms of the lives it cuts short and the lasting disabilities it causes, St. Jude Children’s Research Hospital investigators said in a groundbreaking study published this week.
Traditional analyses of pediatric cancers focused on the number of cases and deaths, with both figures ranging in the hundreds of thousands annually. But the new study, using a different metric, estimated that in 2017 children worldwide lost a total of 11.5 million years to disability or death from cancer, with low- and middle-income countries in Asia, Africa and Central and South America impacted most severely.
With the measure known as disability-adjusted life years — the sum of the years of lives lost and years lived with disability — health officials now can more accurately compare the burden of pediatric cancer with such other diseases as tuberculosis and HIV infection, researchers say. That knowledge could help in establishing policy priorities.
The study was led by Dr. Lisa Force of the St. Jude Department of Global Pediatric Medicine, who was first and corresponding author, and Dr. Nickhill Bhakta, of the same department. It appears online in Lancet Oncology.
“By looking at a different metric, disability-adjusted life years, we can now show for the first time that the burden of disease due to childhood cancer is significant and underappreciated in both the cancer and child health communities,” Bhakta said.
Last year, St. Jude joined with the Institute for Health Metrics and Evaluation at the University of Washington to come up with better estimates of the childhood cancer burden. The institute, with collaborators in some 150 countries, provides estimates for 359 diseases and injuries worldwide in what is known as the Global Burden of Disease study.
The St. Jude analysis builds on data collected in the 2017 global burden study. It found that of the 11.5 million disability-adjusted life years lost, 97.3 percent resulted from cancer deaths at young ages.
The report comes more than a year after the hospital launched a $100 million initiative to bring cancer care within reach of more of the world’s children. It also follows the announcement last September of a five-year collaboration between St. Jude and the World Health Organization to raise survival rates worldwide to 60 percent for six of the most common pediatric cancers.
The global challenges of treating childhood cancer can be not only medical but cultural, Daniel Mckenzie, executive director of Kidzcan Children’s Cancer Relief in Zimbabwe, said during a 2018 visit to St. Jude. Addressing members of ALSAC, the fundraising and awareness organization of St. Jude, he said the majority of people in his country live in rural areas and are less likely to be served by traditional medical facilities.
Mckenzie said his two visits to St. Jude and ALSAC have been “like coming to receive an energy boost,” because of what he’s learned. “It’s what you’re teaching us that we’re taking back,” he said. “You might not know the name of the child, or be able even to pronounce the name of the village where the child comes from, but what you’re doing here has an impact on that child.”
St. Jude, founded in 1962, has led the way in raising the survival rate for childhood cancer from 20 percent to more than 80 percent in the U.S.
But more than 90 percent of pediatric cancers occur in low- and middle-income countries, where access to care often is limited and many kids go undiagnosed.
Other authors of the study include Christina Fitzmaurice, M.D., of the University of Washington, along with more than 130 members of the Global Burden of Disease 2017 Childhood Cancer Collaboration.