Childhood cancer: the need to invest in the future

Abstract

The past decade saw an unprecedented political momentum to accelerate innovation and access to care for patients with cancer, with the 2016 National Cancer Institute's Cancer Moonshot in the USA and the announcement of a European equivalent, the EU's 2021–27 research programme. Yet, although cancer is the leading cause of death by disease in children in both regions, paediatric cancer is often left behind in these major investment programmes. In its December 2019 issue, The Lancet Oncology published the first in-depth global analysis of public and philanthropic funding for childhood cancer research. The identification of 3414 active grants from 115 funders across 35 countries in 2008–16 confirmed that funding for childhood cancer is inadequate and inequitable. Eva M Loucaides (University College London Hospital, London, UK) and colleagues estimated that of the US$2 billion global funding for childhood cancer research in 2008–16, $1·6 billion (78%) was awarded from, and to, institutions based in the USA. Worldwide, the dependence on US funds for advancing childhood cancer research makes the continuity of this research vulnerable and unavoidably leaves behind children with cancer types that are not prioritised in the USA's childhood cancer spending plans. Indeed, although funding levels generally align with the estimated incidence of each cancer type, a notable exception is childhood lymphoma; endemic to Africa, Burkitt lymphoma comprises 30–50% of all childhood cancers in Africa's equatorial region and is of low priority for most organisations contributing to and allocating the insufficient global childhood cancer fund. The consideration of childhood cancer as a political priority has varied widely across countries and seems to depend on stakeholder power dynamics, influenced by the presence of dedicated organisations and local advocacy groups. Loucaides and colleagues highlight the near-absence of funders and grant recipients in South America, Africa, and southeast Asia, which is disconcerting given that 90% of deaths due to childhood cancers in 2018 were in low-income and middle-income countries (LMICs). In haematological malignancies, progress has been remarkable in research therapies for patients with acute lymphoblastic leukaemia in the past decade; nevertheless, the disparity in childhood 5-year survival ranges from less than 60% in China, Ecuador, and Mexico to more than 95% in Scandinavia. The reasons for this decreased survival in LMICs include no access to essential medicines, inadequate infrastructure to support early diagnosis, and lack of organisational capacity to monitor disease progression and ensure adherence to treatment. To reduce disparities in childhood cancer survival between LMICs versus high-income countries, WHO announced in 2018 its Global Childhood Cancer Initiative aiming to achieve at least 60% survival for all children diagnosed with cancer globally by 2030. This ambitious global initiative will be crucial to raise awareness in regions currently missing from the global childhood cancer research fund map and to highlight priority research areas in resource-constrained settings. Regarding funds allocation by research focus, key priority areas especially needed to deliver improved care in LMICs have been notably underfunded. In 2008–16, most grants awarded worldwide focused on biology, epidemiology, and treatment of childhood cancers, with little funding directed towards prevention, survivorship, and palliative care. These data highlight the relevance of the focus of this year's International Childhood Cancer Day (Feb 15)—reducing cancer and treatment-related pain through ensuring access to quality palliative care for children. In 2019, we celebrated the renewed commitments to childhood cancer research, with the European Parliament launching a manifesto on Paediatric Oncology and Haematology, and the US administration announcing a US$500 million fund over 10 years. This year, at The Lancet, we have started the #Lancet2020 advocacy campaign on child and adolescent health, aiming to support the development, mobilisation, and exposure of research in this field by engaging with political leaders, policy makers, non-governmental organisations, researchers and clinicians, funders, and children and young people themselves. We hope that these initiatives, along with WHO's Global Childhood Cancer programme, will provide visibility to childhood cancer, long missing from the global non-communicable diseases and child health agendas. This is a unique moment to invest in a healthy future for all, and the haematology–oncology community can play a key role in achieving this goal.