Abstract
SummaryBackgroundAccurate childhood cancer burden data are crucial for resource planning and health policy prioritisation. Model-based estimates are necessary because cancer surveillance data are scarce or non-existent in many countries. Although global incidence and mortality estimates are available, there are no previous analyses of the global burden of childhood cancer represented in disability-adjusted life-years (DALYs).MethodsUsing the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 methodology, childhood (ages 0–19 years) cancer mortality was estimated by use of vital registration system data, verbal autopsy data, and population-based cancer registry incidence data, which were transformed to mortality estimates through modelled mortality-to-incidence ratios (MIRs). Childhood cancer incidence was estimated using the mortality estimates and corresponding MIRs. Prevalence estimates were calculated by using MIR to model survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated by multiplying age-specific cancer deaths by the difference between the age of death and a reference life expectancy. DALYs were calculated as the sum of YLLs and YLDs. Final point estimates are reported with 95% uncertainty intervals.FindingsGlobally, in 2017, there were 11·5 million (95% uncertainty interval 10·6–12·3) DALYs due to childhood cancer, 97·3% (97·3–97·3) of which were attributable to YLLs and 2·7% (2·7–2·7) of which were attributable to YLDs. Childhood cancer was the sixth leading cause of total cancer burden globally and the ninth leading cause of childhood disease burden globally. 82·2% (82·1–82·2) of global childhood cancer DALYs occurred in low, low-middle, or middle Socio-demographic Index locations, whereas 50·3% (50·3–50·3) of adult cancer DALYs occurred in these same locations. Cancers that are uncategorised in the current GBD framework comprised 26·5% (26·5–26·5) of global childhood cancer DALYs.InterpretationThe GBD 2017 results call attention to the substantial burden of childhood cancer globally, which disproportionately affects populations in resource-limited settings. The use of DALY-based estimates is crucial in demonstrating that childhood cancer burden represents an important global cancer and child health concern.FundingBill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities (ALSAC), and St. Baldrick's Foundation.
Highlights
Added value of this study To our knowledge, we report for the first time the global and regional estimates of childhood cancer burden using Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 results, with disability-adjusted life-years (DALYs) as the outcome measure, providing a new perspective on the global burden childhood cancer to that previously available in published literature
Prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and DALYs are generated for each disease and injury, with each metric reported by year, location, age group, and sex
The mortality estimates derived with this approach were pooled with the directly obtained mortality data from vital registration systems and verbal autopsies, and used in cancer-specific Cause of Death Ensemble models (CODEm), which are necessary because mortality data do not exist for every age, sex, location, and year combination estimated by GBD 2017.16 The CODEm approach uses all available www.thelancet.com/oncology Vol 20 September 2019
Summary
Children with cancer who live in high-income countries (HICs) have good outcomes, with approximately 80% surviving 5 years after their diagnosis. more than 90% of children at risk of developing childhood cancer each year live in low-income and middle-income countries (LMICs). Considered by many as one of the major advances of modern science, the improvement in outcomes in children with cancer seen in HICs over the past several decades has not translated to most LMICs, where existing data suggest that far fewer children survive. An accurate appraisal of childhood cancer incidence and outcomes is non-existent in many LMICs, due in part to a lack of the cancer registry and vital registration systems necessary to record and report these data. Childhood cancers are often fatal without appropriate and timely diagnosis and treatment and, by contrast with adult cancers, there are no evidencebased population screening programmes or lifestyle risk-reduction strategies that are effective in improving outcomes. As a result, increasing survival will require considerable planning by policy makers to ensure adequate resource allocation and health system function. Children with cancer who live in high-income countries (HICs) have good outcomes, with approximately 80% surviving 5 years after their diagnosis.. More than 90% of children at risk of developing childhood cancer each year live in low-income and middle-income countries (LMICs).. Considered by many as one of the major advances of modern science, the improvement in outcomes in children with cancer seen in HICs over the past several decades has not translated to most LMICs, where existing data suggest that far fewer children survive.. An accurate appraisal of childhood cancer incidence and outcomes is non-existent in many LMICs, due in part to a lack of the cancer registry and vital registration systems necessary to record and report these data.. Information on the burden of childhood cancer is crucial to informing these efforts and model-based estimates are necessary to determine cancer burden in settings without data until cancer data coverage improves
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