Worldwide, more than 11 million years of healthy life have been lost due to childhood cancer in 2017 – ScienceDaily

Children in the poorest countries face a disproportionate burden of cancer – accounting for over 82% of the global burden of childhood cancer – equivalent to nearly 9.5 million years of healthy life lost in 2017. Most (97%) of this global burden is related to premature death, with about 3% due to a deterioration in the quality of life.

For the first time, researchers provide a comprehensive picture of the global and regional burden of childhood cancer beyond incidence, mortality and survival. The study estimates the number of years of healthy life lost by children and teens with cancer due to illness, disability, and premature death – a measure known as the D & D. Years of life corrected for disability (DALY). A DALY equals a year of healthy life lost. However, disability among childhood cancer survivors was limited to the first 10 years after the diagnosis of cancer, not to the whole of life; the global burden of DALYs badociated with childhood cancer is therefore probably underestimated, according to the researchers.

"By badessing the global burden of childhood cancer in terms of disability-adjusted life years, we can better understand the devastating impact of cancer on children around the world," says Dr. Lisa Force, of the St Jude Children's Research Hospital in the United States, who led the research in collaboration with the Institute for Health Metrics and Evaluation. "Our findings are an important first step in establishing that childhood cancer plays a role in settings that deal with the global oncology and health of children."

Children with cancer living in high-income countries generally have good survival, about 80% of them surviving five years after diagnosis. But these improvements have not translated into most low- and middle-income countries (LMICs), where survival is around 35 to 40 percent, but some estimates suggest that this could be 20 percent. About 90% of children at risk of developing cancer live in LICs.

"Improving childhood cancer survival will require considerable planning by policymakers to ensure the smooth functioning of health systems capable of early diagnosis and treatment," he said. said Dr. Force. "Evaluating the number of years of healthy life that children have lost to cancer allows decision-makers to compare the consequences of childhood cancer throughout their lives and help them determine the most effective way to spend limited resources and to identify cancer planning decisions that have a significant impact. "

In the study, global and regional estimates were badyzed using the Socio-Demographic Index (SDI), a measure based on education rates, fertility, and fertility. returned. High IDS countries have high levels of income and education and low fertility, while low SDI countries have low levels of income and education and high fertility.

The study reveals striking inequalities in the cancer burden among children between high and low SDI countries (table). Countries with high and medium-high IDS accounted for about 35% (147,300) of new childhood cancer cases in 2017, but only 18% of DALYs (about 2 million years of life in good lost health), while countries with low, medium and low IDS with 38% of the global incidence (159,600 new cases) accounted for 60% of DALYs (nearly 7 million years of life in good lost health).

In addition, research has shown that childhood cancers are a major cause of the global burden of disease compared to adult cancers and other childhood diseases. In 2017, childhood cancers were the sixth leading cause of years of healthy life lost from all cancers worldwide (11.5 million), only less than lung cancers in adults ( 41 million), liver (21 million), stomach (19 million), colon (19 million) and bad (18 million). In low and middle IDS countries, childhood cancers were the leading cause of DALYs, higher than the burden attributable to one type of cancer in adults.

The study estimates the annual number of childhood cancers to more than 11.5 million years of healthy life lost in 2017. This compares to about 37 million years of healthy life. lost worldwide due to malaria and 7.6 million people with TB. In 2017, childhood cancer was among the top four contributors to the burden of general childhood illness in medium- and high-medium SID countries, ranking higher than malaria and HIV / AIDS.

While four of the five countries most affected by childhood cancer were in Asia and Oceania (India, China, Pakistan and Indonesia), the United States had the sixth-highest burden in 2017 and Africa Sub-Saharan, the heaviest burden of DALY cancer types in children than any other region.

Blood cancers (leukemias) were the main contributors to all DALYs, accounting for 34% of the total burden of childhood cancer worldwide, followed by brain and nervous system cancers (18%). In 2017, the proportion of the burden of leukemia and brain cancer differed by almost three times between regions. The proportional burden of leukemia was highest in Central and Andean Latin America (49% of all childhood cancers) and the highest absolute burden in South Asia (954,000 DALY).

The authors point out that the mechanisms for controlling the burden of cancer in adults, focused on harm reduction strategies and screening interventions, are not as relevant for childhood cancers as childhood cancers progress. usually quickly. precancerous tumors and are fatal without rapid diagnosis and treatment. This underscores the critical role that early diagnosis and treatment will play in reducing the global cancer burden in children.

Despite these important findings, the methodology used to estimate the cancer burden in children has several limitations that need to be addressed, say the authors. Although the study uses the best available data, predictions are limited by the lack of high quality cancer data, especially in developing countries – highlighting the need to expand quality and quantity Population-based cancer registration systems and include pediatric data. specific cancer registries. They also note that the current site-based adult cancer reporting system leaves more than 26% of the childhood cancer burden (3 million DALYs) related to unclbadified cancers, a difficult category for political decision-making. , financial and clinical.

In an accompanying editorial, the editors of The Lancet Child & Adolescent Health write: "The universal language of data offers a substantial opportunity to those struggling against the global burden of cancer in children. DALY burden badysis by country and subtype of cancer shows The collection of national data on childhood cancer can guide investments in training specialists to ensure earlier diagnoses, providing equitable access to medicines, reducing number of deaths and improve survivor care and quality of life ".

In a related commentary, Charles Stiller of Public Health England, UK, discusses what can be done to reduce or even reduce the global burden of cancer in children and adolescents. He writes: "Early diagnosis can lead to a substantial reduction in mortality and long-term morbidity, although the gains from early diagnosis should be greatest in low-resource countries, where too many cases are diagnosed at an advanced stage, they should be felt even in rich countries, especially for people with low-grade brain tumors, whose survivors bear a heavy burden of disability.To fully benefit from early diagnosis, It must be accompanied by better diagnostic and treatment facilities that provide universal access, and will be an essential part of the necessary capacity building, and we hope that this study will help stimulate the necessary improvements and that future iterations can control its success. "