Treating Childhood Cancers in Low- and Middle-Income Countries
Authors: Sumit Gupta, Scott Howard, Stephen Hunger, Federico Antillon, Monika Metzger, Trijn Israels, M'hamed Harif, Carlos Rodriguez-Galindo
Childhood cancer is severely underrepresented in low- and middle-income country (LMIC) cancer registries despite the diagnosis of 175,000 children globally annually. In high-income countries (HICs) over 80 percent of children with cancer are cured, but LMIC cure rates remain significantly lower due to the need for specialized care centers and shortages of essential chemotherapy. Twinning programs allying LMIC hospitals with HIC cancer treatment centers show great effectiveness. Avoiding overtreatment is crucial in LMICs, emphasizing the need for locally adapted treatment protocols. Efforts have tried to decrease abandonment of therapy rates which ranged from 3 percent to an astonishing 74 percent. The most common childhood cancers – acute lymphoblastic leukemia, Hodgkin lymphoma, Wilms tumor, Burkitt lymphoma, and retinoblastoma – are analyzed for detection, treatment, and costs of treatment. Cost-effectiveness in pediatric oncology should consider factors of (1) using lower intensity treatment regimens, (2) expanding the resource pool from which to obtain funds, and (3) appealing to justice, equity, and societal value of children’s lives.