New research indicates that childhood cancer cuts more lives short and imposes a bigger burden on society than all but a handful of diseases. Apart from cutting short young lives, cancer also burdens children with disabilities.
Childhood cancer may be relatively rare, but in terms of disability and years of life lost it ranks near the top of the list of all cancers and other childhood diseases, a new study shows.
The study quantifies for the first time the global scale of the burden cancer imposes on children, their families and even governments. Researchers used a measure called disability-adjusted life-years (DALYs), which was developed to assess the health of countries’ populations so that policymakers can identify their top health care priorities.
Drs. Lisa Force and Nickhill Bhakta, of St. Jude Children’s Research Hospital in Memphis, Tennessee, and Dr. Christina Fitzmaurice, of the University of Washington’s Institute for Health Metrics and Evaluation in Seattle, estimate that childhood cancers resulted in 11.5 million DALYs around the world in 2017.
Viewed through this prism, childhood cancer outranks all but a very few diseases in the toll it takes by cutting short young lives and burdening children with disabilities.
Based on previous calculations, which estimated that about 200,000 new cancer cases occur each year, childhood cancer ranks sixth among all cancers and ninth among childhood diseases worldwide, the authors report Monday in the journal Lancet Oncology.
Newer estimates by Bhakta and colleagues at Harvard University, however, are higher. Those calculations suggest that the number of children diagnosed annually with cancer around the world – including wealthy countries – is approximately 400,000 – twice the number that was previously recognised.
That would boost childhood cancer to second among all cancers, after lung, and fifth among childhood diseases, after lower respiratory infections, diarrhea, congenital birth defects and malaria.
Even this figure is likely an understatement, researchers say. They blame a variety of factors, such as a lack of reliable data and the use of diagnostic techniques that work well for adults but are not as trustworthy for children.
Their research also shows that the burden of cancer disproportionately affects people in low- and middle-income countries, where resources to diagnose and treat the disease are scarce. Children in the poorest countries account for more than 82% of the global childhood cancer burden, which is equivalent to almost 9.5 million years of healthy life lost in 2017.
This information is especially powerful in those settings, where policymakers must weigh the impact of every dollar they spend, Bhakta says. “Though it pains me as a physician to think in these terms, you have to choose which interventions are going to carry the biggest bang for the buck.”
Dr. Robert Goldsby, a pediatric cancer specialist at UCSF Benioff Children’s Hospital, says a lack of resources can have a profound impact on how well, or badly, a child fares. A child who can’t get to the hospital to get chemotherapy or whose parents are struggling to put healthy food on the table is far less likely to recover than a child who gets optimal care and support, he says.
India, China, Nigeria, Pakistan, Indonesia, have the largest burden of childhood cancer among countries with the biggest populations of children. Ninety-seven percent of the global burden is linked to early death and possibly 3% to impaired quality of life.
“By assessing the global burden of childhood cancer through the lens of disability-adjusted life-years, we can more comprehensively understand the devastating impact of cancer on children globally,” said Force, who led the research, in a statement.
Children with cancer who live in high-income countries tend to have a five-year survival rate of greater than 80%. But those improvements have not translated to most low- and middle-income countries, where just 10% to 30% of patients may survive. Roughly 90% of children at risk of developing cancer live in low- and middle-income countries.
Leukaemia was the main contributor to overall DALYs, accounting for just over one-third of the total childhood cancer burden worldwide, followed by brain and nervous system cancers, which accounted for one-fifth.