Burden Of Childhood Cancer Research Articles

Study of Mortality Rate and its Causes among Egyptian Children and Adolescents with Cancer

Abstract Background There is little evidence about the burden of childhood cancers in Egypt. Knowledge about the current disease burden of childhood cancers is crucial to priorities cancer control plans and improve survival. Objective To describe the frequency of deaths among children diagnosed with cancer in the last 10 years. Patients and Methods This retrospective descriptive study was conducted in Pediatric Hematology /Oncology Unit, Children's Hospital, Ain Shams University. The data of 500 patients was collected from the database in the period from 1st September 2011 to 30th September 2021. The study included 500 Children less than 18 years diagnosed as solid and hematological malignancies. Results The median age of the included patients was 4.25 years, males represented 54.4%. The most common etiology of malignancies among the included patients were: acute lymphoblastic leukemia (31.8%) and acute myeloid leukemia (714.6%). Death was evident in 71.4% of the included patients. Among the dead cases 106 (74.12%) had late death; that occurred 5 years or more after diagnosis and 37(25.4%) had early death; that occurred within 30 days after diagnosis of the first neoplasm. The higher mortality was reported among acute lymphoblastic leukemia (52; 36.4%), acute myeloid leukemia (28; 19.6%), neuroblastoma (13; 9.1%) and brain tumors (10; 7.0%). Comparison between living and dead childhood cancer patients as regards the demographic and clinical data showed no significant difference regarding; age, gender, and residence (P-value= 0.591, 0.122 & 0.077, respectively). Relapse was significantly increased among dead cases representing 32.9% (P-value= 0.000). Conclusion In our institute, childhood cancer patients’ mortality rate was 28.5% in the last 10 years. Early death occurred in (25.8%) among them; infection was the leading cause of death, while primary malignancy was the main cause of death among those who died late, which is almost comparable with international studies. Furthermore, the overall survival of our childhood with cancer was (67.30%) at 5 years from diagnosis. This is relatively better than the previous published Egyptian data and reaching international figures.

Burden of Childhood Cancer and the Social and Economic Challenges in Adulthood

Significant advancements in pediatric oncology have led to a continuously growing population of survivors. Although extensive research is being conducted on the short-, medium-, and long-term somatic effects, reports on psychosocial reintegration are often conflicting; therefore, there is an urgent need to synthesize the evidence to obtain the clearest understanding and the most comprehensive answer. To provide a comprehensive review and analysis of the socioeconomic attainment of childhood cancer survivors (CCSs) compared with their unaffected peers. A systematic review and meta-analysis was conducted using data obtained from a comprehensive search of MEDLINE (via PubMed), Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases on October 23, 2021; the search was updated until July 31, 2023. Eligible articles reported on educational attainment, employment, family formation, quality of life (QoL), or health-risk behavior-related outcomes of CCSs, and compared them with their unaffected peers. Study selection was performed in duplicate by 4 blinded independent coauthors. Data extraction was performed in duplicate by 4 independent authors following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures were odds ratios (ORs) and mean differences with 95% CIs; data were pooled using a random-effects model. The search identified 43 913 articles, 280 of which were eligible for analysis, reporting data on a total of 389 502 survivors. CCSs were less likely to complete higher levels of education (OR, 0.69; 95% CI, 0.40-1.18), had higher odds of health-related unemployment (OR, 2.94; 95% CI, 1.90-4.57), and showed lower rates of marriage (OR, 0.72; 95% CI, 0.63-0.84) and parenthood (OR, 0.60; 95% CI, 0.49-0.74) compared with population-based controls. Study findings suggest that CCSs face several socioeconomic difficulties; as a result, the next goal of pediatric oncology should be to minimize adverse effects, as well as to provide lifelong survivorship support aimed at maximizing social reintegration.

An overview of childhood cancer care and outcomes in Egypt: a narrative review.

Childhood cancer is an urgent priority in Egypt, owing to a large number of children with cancer, the great need and demand for paediatric oncology services, limited resources/funds and inferior survival outcomes. Therefore, an overview of the status of childhood cancer care in Egypt and an evidence-based approach towards optimal utilisation of resources/funds to improve this care are needed. This paper summarises key evidence about childhood cancer care and outcomes in Egypt. We conducted a narrative literature review using a structured search strategy of the MEDLINE database through the PubMed interface. All relevant evidence was summarised under five main sub-topics: (1) burden of childhood cancer in Egypt; (2) treatment approaches; (3) health outcomes; (4) costs and cost-effectiveness of treatment; and (5) barriers and facilitators to optimal childhood cancer care. We found high estimates of disease burden of childhood cancer in Egypt. Furthermore, childhood cancer treatment in Egypt is based on either implementing intensity-regulated protocols or adopting international protocols with or without adaptations to local contexts, leading to varying standards of care among the different treating centres. Limited data about the survival outcomes, costs and cost-effectiveness of treatment exist, although high-quality data from retrospective cohort studies were published from a large paediatric oncology centre (Children's Cancer Hospital Egypt-57357). As Egypt joins the WHO Global Initiative for Childhood Cancers as a focus country, it is prepared to move towards streamlining national efforts to implement a national childhood cancer plan to advance care, improve health outcomes and optimise resource use. Through these efforts, Egypt could become a beacon of hope and a role model to other low- and middle-income countries seeking to improve their childhood cancer care.

Incidence and pattern of childhood cancer in Addis Ababa, Ethiopia (2012–2017)

BackgroundCancer is becoming a major public health problem globally and a leading cause of death in children in developed countries. However, little is known about the epidemiology of childhood cancer in Ethiopia. This study, therefore, assessed childhood cancer incidence patterns in Addis Ababa using the Addis Ababa city population-based cancer registry data from 2012 to 2017.MethodsInvasive cancer cases diagnosed in ages 0–14 years from 2012 to 2017 were obtained from the Addis Ababa City population-based Cancer Registry. Cases were grouped according to the International Classification of Childhood Cancer, 3rd edition (ICCC-3) based on morphology and primary anatomic site. Age-standardized incidence rates (ASR) were calculated by the direct method using the world standard population.ResultsThe overall average annual incidence rate during 2012–2017 in children was 84.6 cases per million, with rates higher in boys (98.97 per million) than in girls (69.7 per million). By age, incidence rates per million increased from 70.8 cases in ages 0–4 years to 88.4 cases in ages 5–9 years to 110.0 cases 10–14 years. Leukaemia was the most common childhood cancer in both boys (29.1%) and girls (26.8%), followed by lymphoma in boys (24.7%) and renal tumours (13.1%) in girls. The overall cancer incidence rate decreased from 87.02 per million in 2012 to 51.07 per million in 2017.ConclusionThe burden of childhood cancer is considerably high in Addis Ababa. The observed distribution of childhood cancer in Addis Ababa differs from other African countries. This study highlights the need for further research and understanding of the variations in cancer patterns and risk factors across the region.

Sickle cell allele HBB-rs334(T) is associated with decreased risk of childhood Burkitt lymphoma in East Africa.

Burkitt lymphoma (BL) is an aggressive B-cell lymphoma that significantly contributes to childhood cancer burden in sub-Saharan Africa. Plasmodium falciparum, which causes malaria, is geographically associated with BL, but the evidence remains insufficient for causal inference. Inference could be strengthened by demonstrating that mendelian genes known to protect against malaria-such as the sickle cell trait variant, HBB-rs334(T)-also protect against BL. We investigated this hypothesis among 800 BL cases and 3845 controls in four East African countries using genome-scan data to detect polymorphisms in 22 genes known to affect malaria risk. We fit generalized linear mixed models to estimate odds ratios (OR) and 95% confidence intervals (95% CI), controlling for age, sex, country, and ancestry. The ORs of the loci with BL and P. falciparum infection among controls were correlated (Spearman's ρ = 0.37, p = .039). HBB-rs334(T) was associated with lower P. falciparum infection risk among controls (OR = 0.752, 95% CI 0.628-0.9; p = .00189) and BL risk (OR = 0.687, 95% CI 0.533-0.885; p = .0037). ABO-rs8176703(T) was associated with decreased risk of BL (OR = 0.591, 95% CI 0.379-0.992; p = .00271), but not of P. falciparum infection. Our results increase support for the etiological correlation between P. falciparum and BL risk.

A province-wide childhood malignancy profiles in Indonesia (2010-2019): Yogyakarta Pediatric Cancer Registry

Background The global burden of childhood cancer is poorly quantified, but it is estimated that 80% of all children with cancer live in low- and middle-income countries with cure rates of childhood cancer far lower than in high-income nations.
 Objective To describe the Yogyakarta Region pediatric cancer profile from 2010-2019 and compare it to that of a 2000-2009 study in the same setting.
 Methods This retrospective study of childhood cancer was conducted in patients aged £18 years and diagnosed in Dr. Sardjito General Hospital from 2010 to 2019. Pediatric cancer patient data were collected from hospital hardcopy and electronic medical records. An estimated annual average incidence rate of childhood cancer was calculated and the number of patients by their regions of origin were visualized. The number of childhood malignancies recorded is also compared by the number found in 2000-2009 study.
 Results There were 1,839 new cases registered in Yogyakarta Pediatric Cancer Registry during the study period. The mean age at diagnosis was 6.3 years and male-to-female ratio was 1.4: 1.0. Fifty-six% of cancers were diagnosed in the 0-5-years age group. The most common diagnosis category was leukemia, which accounted for 60% of all childhood malignancies. The three most common diagnoses were acute lymphoblastic leukemia (44%), acute myeloid leukemia (12%), and retinoblastoma (7%). The annual average incidence rates of leukemia and solid tumors were 26.8 and 17.5 per million, respectively. The number of patients registered in 2000-2009 study was 1,124 case. Therefore, there was an increase of 63.6% in the number of childhood malignancies registered in 2010-2019 compared to the 2000-2009 study.
 Conclusion There is an increase in the number of childhood malignancies registered in 2010-2019 compared to the 2000-2009 study. The number of patients referred to our hospital increased, indicating a more inclusive registry, better referral system, and better access to health care facility.

Outcomes among survivors of childhood cancer in low- and middle-income countries: A systematic review.

10057 Background: Low- and middle-income countries (LMICs) account for most of the global childhood cancer burden. Though cure rates lag behind those in high-income countries (HICs), a substantial proportion of LMIC children do survive. Long-term side effects of cancer or cancer therapy (late effects) are well-documented among childhood cancer survivors (CCS) in HICs, but whether prevalence and risk factors of late effects are comparable in LMICs is unclear. We thus conducted a systematic review to assess LMIC CCS outcomes. Methods: Five major health sciences databases were searched from inception to November 2022 in all languages. We included observational studies conducted in LMICs (World Bank 2021 classification) that evaluated outcomes in CCSs diagnosed with any malignancy. Mean or median length of follow-up must have been ≥ 5 years from original cancer diagnosis. Meta-analyses were precluded by cohort and outcome heterogeneity. Results: Of 1,994 studies identified, 113 underwent full-text review and 21 met inclusion criteria (16 full articles and 5 conference abstracts). Studies were conducted in lower-middle income (N = 12, 57%) or upper-middle income (N = 9, 43%) countries; no low-income country data were found. Study regions were mainly South and East Asia (N = 10, 48%) and the Americas (N = 8, 38%). Almost half (N = 9, 43%) of studies were conducted in India and only one African study from Cameroon was identified. Over half (N = 12, 57%) of studies were cross-sectional in design. Only five (24%) cohorts were comprised entirely of 5-year survivors. CCS of all childhood cancer types were evaluated in 12 (57%) cohorts, and 9 (43%) were specific to one cancer type. Ten (48%) studies were conducted in a survivorship clinic. Second cancers, followed by endocrine, reproductive, and cardiovascular late effects were most frequently assessed. Second cancers were reported in 1%–11% of CCS cohorts (N = 10 studies). The prevalence of hypothyroidism and metabolic syndrome ranged from 2%-49% (N = 6 studies) and 4%-17% (N = 5 studies), respectively. Gonadal dysfunction ranged from 2%-82% (N = 6 studies). Cardiac dysfunction and hypertension ranged from 1%-16% (N = 3 studies) and 5-19% (N = 3 studies), respectively. Late effects of the musculoskeletal (N = 4 studies) and urinary (N = 4 studies) systems were least investigated. Conclusions: Substantial knowledge gaps exist in LMIC childhood cancer survivorship. Few LMIC-based studies were identified, with no low-income country data available. In middle-income countries, variability existed in how late effects were defined and assessed; data was also limited by selection bias and small sample sizes. Additional systematically collected data on LMIC CCS cohorts are urgently needed.

Access to essential cancer medicines for children: a comparative mixed-methods analysis of availability, price, and health-system determinants in east Africa.

Access to essential childhood cancer medicines is a core determinant of childhood cancer outcomes. Available evidence, although scarce, suggests that access to these medicines is highly variable across countries, particularly in low-income and middle-income countries, where the burden of childhood cancer is greatest. To support evidence-informed national and regional policies for improved childhood cancer outcomes, we aimed to analyse access to essential childhood cancer medicines in four east African countries-Kenya, Rwanda, Tanzania, and Uganda-by determining the availability and price of these medicines and the health system determinants of access. In this comparative analysis, we used prospective mixed-method analyses to track and analyse the availability and price of essential childhood cancer medicines, investigate contextual determinants of access to childhood cancer medicines within and across included countries, and assess the potential effects of medicine stockouts on treatment. Eight tertiary care hospitals were included, seven were public sites (Kenyatta National Hospital [KNH; Nairobi, Kenya], Jaramogi Oginga Odinga Referral and Teaching Hospital [JOORTH; Kisumu, Kenya], Moi University Teaching and Referral Hospital [MTRH; Eldoret, Kenya], Bugando Medical Centre [BMC; Mwanza, Tanzania], Muhimbili National Hospital [MNH; Dar es Salaam, Tanzania], Butaro Cancer Centre of Excellence [BCCE; Butaro Sector, Rwanda], and Uganda Cancer Institute [UCI; Kampala, Uganda]) and one was a private site (Aga Khan University Hospital [AKU; Nairobi, Kenya]). We catalogued prices and stockouts for 37 essential drugs from each of the eight study siteson the basis of 52 weeks of prospective data that was collected across sites from May 1, 2020, to Jan 31, 2022. We analysed determinants of medicine access using thematic analysis of academic literature, policy documents, and semi-structured interviews from a purposive sample of health system stakeholders. Recurrent stockouts of a wide range of cytotoxic and supportive care medicines were observed across sites, with highest mean unavailability in Kenya (JOORTH; 48·5%), Rwanda (BCCE; 39·0%), and Tanzania (BMC; 32·2%). Drugs that had frequent stockouts across at least four sites included methotrexate, bleomycin, etoposide, ifosfamide, oral morphine, and allopurinol. Average median price ratio of medicines at each site was within WHO's internationally accepted threshold for efficient procurement (median price ratio ≤1·5). The effect of stockouts on treatment was noted across most sites, with the greatest potential for treatment interruptions in patients with Hodgkin lymphoma, retinoblastoma, and acute lymphocytic leukaemia. Policy prioritisation of childhood cancers, health financing and coverage, medicine procurement and supply chain management, and health system infrastructure emerged as four prominent determinants of access when the stratified purposive sample of key informants (n=64) across all four countries (Kenya n=19, Rwanda n=15, Tanzania n=13, and Uganda n=17) was interviewed. Access to childhood cancer medicines across east Africa is marked by gaps in availability that have implications for effective treatment delivery for a range of childhood cancers. Our findings provide detailed evidence of barriers to access to childhood cancer medicine at multiple points in the pharmaceutical value chain. These data could inform national and regional policy makers to optimise cancer medicine availability and affordability as part of efforts to improve childhood cancer outcomes specific regions and internationally. American Childhood Cancer Organization, Childhood Cancer International, and the Friends of Cancer Patients Ameera Fund.

Pediatric Cancer in the Northeast United States—Reply

Our article (1) set out to analyze data relating to childhood cancer following Dr. Siegel's Centers for Disease Control and Prevention (CDC) descriptive study in 2018 (2) in which a headline result was that “rates were highest in New Hampshire.” Messmer raises several questions, which seem to distill to: (i) was our conclusion appropriate, that New Hampshire's (NH) incidence of childhood cancer was not statistically significantly higher than the rest of the Northeast; (ii) did we draw conclusions beyond the scope of the analyses; and (iii) how should resources be directed in the goal of preventing childhood cancer?(i) When all races are analyzed together, NH has the highest incidence of all states, but as we reported, it is not a statistical outlier. However, incidence varied across race/ethnicity groups by more than 38% and was highest in White children (Table 1; ref. 1), making race/ethnicity a potentially important confounder. To avoid the criticism that differences in incidence were simply due to differences in population composition, stratification by race/ethnicity was needed. Both overall and stratified measures are potentially useful, depending on the goal. If we want to discuss the burden of childhood cancer, then overall incidence should be the focus. If we want to make unbiased comparisons as a first step in the journey toward causal inferences, stratifying by major confounders is the methodologically correct approach. We note that NH's age-standardized rates do not rank highest in any race/ethnicity stratum, and this is not dependent on the use of Bonferroni (Table 1; ref. 1). Did the high incidence in NH bias our regional comparisons? NH accounted for only 2.5% of cases in the Northeast, and 2.4% of the population, so this seems unlikely. The Tiwari method of modification that we used means that the comparison we reported is between NH and the rest of the Northeast, and not between NH and the Northeast including NH.(ii) Messmer is incorrect in her assertion that we drew conclusions that de-emphasized any single possible cause of the observed patterns because we drew no conclusions about etiology. Our conclusions are limited to the findings relating to our a priori hypotheses that assessed NH's comparison with the Northeast, and the Northeast's comparison with other regions. We presented a balanced discussion of many possible causes but drew no conclusions about them.(iii) Our study was a first step toward identifying the extent of the problem, and we believe our neighbors in the Northeast should be as deeply concerned about childhood cancer as we are in NH. A different kind of study is needed to explore the reasons for these patterns, but etiologic research requires large numbers of participants with detailed individual-level data which are not readily available and this would be difficult to conduct in a single state with a relatively small number of cancers. The NCI is leading the National Childhood Cancer Data Initiative to pool data from many sources and states for research, recognizing that, “due to their rare nature, it has been challenging to collect substantial and vital information on a large scale to study and understand the needs for this unique population of cancer patients.” (3) NH is eligible to participate.NH and neighboring states each have special local concerns about high pediatric cancer incidence, pollution, and other factors. Arguments over whether NH ranks #1 are distracting; clearly the state's very high incidence should be investigated, but our findings open the door to a larger effort, if those involved in government throughout the Northeast act together on their collective responsibility. A Northeastern coalition could pool resources toward the conduct of research that includes local areas of concern in multiple states, because large-scale, rigorously designed and analyzed studies of childhood cancer etiology have the greatest chance of determining causes.The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of the New Hampshire Department of Environmental Services, the New Hampshire Department of Health and Human Services, or the CDC.See the original Letter to the Editor, p. 149J.R. Rees reports other support from the New Hampshire Department of Health and Human Services during the conduct of the study. M.O. Celaya reports other support from the New Hampshire Department of Health & Human Services during the conduct of the study. No disclosures were reported by the other authors.

Economic and Social Burden of Childhood Cancer in Bangladesh.

Cancer is a major cause of morbidity and mortality worldwide. This study aimed to investigate the scale and nature of the socio-economic burdens that face families of children with pediatric cancer in Bangladesh on a day-to-day basis and the reasons for delays in diagnosis and treatment of the disease. A cross-sectional exploratory study including 54 families in Bangladesh who had children with cancer. A structured questionnaire was used to collect quantitative data, supplemented by open-ended questions to gain in-depth information about specific issues. The majority of children were male (n=39, 72.2%) and aged 6-15 (n=38, 70.4%). Blood cancer (n=20, 37%) and acute lymphocytic leukemia (n=25, 46.3%) were the most common diagnoses. Many parents stopped working after their child's cancer diagnosis (n=28, 51.9%). Many families (n=21, 38.90%) spent more per month (e.g., USD 471-1,179) on their child's treatment than their income. No external financial support was available to cover this high expenditure, putting families under financial pressure. Social issues included fear, lack of cancer awareness, stigma in rural communities, low-quality facilities, inappropriate service provider behavior, poor facility hygiene, and high fees. This study revealed that childhood cancer has a substantial impact on parents' socioeconomic status, and many families face financial, social, and psychological challenges. This highlights the need for urgent collaborative action to address these problems.

Pediatric Neurosurgical Capacity for the Care of Children With CNS Tumors Worldwide: A Cross-Sectional Assessment.

Efforts to address inequities in the treatment of pediatric CNS tumors and the burden of childhood cancer globally have prompted the designation of low-grade glioma as one of six index cancers for the World Health Organization Global Initiative for Childhood Cancer. Understanding the importance of neurosurgical interventions and evaluating pediatric neurosurgical capacity may identify critical interventions to improve outcomes for children with low-grade glioma and other CNS tumors. An online, cross-sectional survey assessing pediatric neurosurgical practice and capacity was distributed to members of the International Society of Pediatric Neurosurgery. The survey included 36 items covering domains including patient volume, available infrastructure, scope of practice, case distribution, and multidisciplinary care. Responses from 196 individuals from 61 countries, spanning all WHO regions, were included. Ninety-six (49.0%) were from high-income countries, 57 (29.1%) were from upper-middle-income countries, 42 (21.4%) were from lower-middle-income countries (LMICs), and 1 was (0.5%) from a low-income country. Most respondents had a catchment population of ≥ 1 million and indicated the availability of basic neurosurgical resources such as a dedicated neurosurgical operating theater and surgical microscope. The presence of a neurosurgical intensive care unit, inpatient rehabilitation services, and infection monitoring showed similar availability across country groups. Quantitative scoring of 13 infrastructure and service items established that fewer resources were available in low-income countries/LMICs and upper-middle-income countries compared with high-income countries. The volume of pediatric CNS tumor cases and case distribution did not vary according to World Bank country groups. This study provides a comprehensive evaluation of pediatric neurosurgical capacity across the globe, establishing variability of resources on the basis of the country income level. Our findings suggest that pediatric neurosurgeons in LMICs may benefit from key neurosurgical instrumentation and increased support for multidisciplinary brain tumor programs and childhood cancer research efforts.

The systematic analysis and 10-year prediction on disease burden of childhood cancer in China.

BackgroundThere is a lack of in-depth analysis regarding the disease burden of childhood cancer in China. Indeed, this is the first time the topic has been addressed in detail. Drawing on population-based data for the past 30 years, this study systematically analyzes the composition and long-term trend of this disease burden in China.MethodsGBD 2019 contained population-based data from 1990 to 2019 and was prepared using Microsoft Excel 2016. We used AAPC and ARIMA models for trend analysis and prediction formulation.ResultsIn 2019, there were 45,601 new cases, 9,156 cancer deaths, and 782,530 DALYs in China. From 1990 to 2019, leukemia, together with brain and CNS cancer, invariably ranked highest in terms of new cases, cancer deaths, and DALYs. Leukemia accounted for more than 50%, but decreased over time. By contrast, the proportions for brain and CNS cancer increased. There were significant decreases in the overall incidence, mortality, and DALY rates in China, but these were still higher than the corresponding global average levels. Considering all types of childhood cancer, the incidence rate of testicular cancer showed the biggest increase, and the mortality and DALY rates of leukemia showed the largest decrease. In terms of different age groups, the overall incidence rate of childhood cancers increased in 0 to 4 age group, but it decreased in 5 to 14 age groups. The overall mortality and DALY rates of childhood cancers decreased in all four age groups. Over the next 10 years, the overall incidence rate of childhood cancer will increase, but the overall mortality and DALY rates will decrease. The increase in malignant skin melanoma will comprise the largest rise in the incidence, while the decrease for leukemia will be the largest fall in the incidence, cancer deaths, and DALYs.ConclusionThe disease burden of all childhood cancers in China remains highly serious, especially for certain types of cancer and certain age groups. China should focus more emphatically on the incidence of childhood cancer in future, and it must consistently strengthen investment in the relevant research and medical resources to reduce the disease burden in this field.

The Relationship between the Unmet Needs of Chinese Family Caregivers and the Quality of Life of Childhood Cancer Patients Undergoing Inpatient Treatment: A Mediation Model through Caregiver Depression.

A large proportion of the global burden of childhood cancer arises in China. These patients have a poor quality of life (QoL) and their family caregivers have high unmet needs. This paper examined the association between the unmet needs of family caregivers and the care recipient’s QoL. A total of 286 childhood cancer caregivers were included in this cross-sectional study. Unmet needs and depression among caregivers were assessed by the Comprehensive Needs Assessment Tool for Cancer Caregivers (CNAT-C) and the Patient Health Questionnaire (PHQ-9), respectively. The patient’s QoL was proxy-reported by the Pediatric Quality of Life Inventory Measurement Models (PedsQL 3.0 scale Cancer Module). Descriptive analyses, independent Student’s t-tests, one-way ANOVA, and mediation analyses were performed. The mean scores (standard deviations) for unmet needs, depression, and QoL were 65.47 (26.24), 9.87 (7.26), and 60.13 (22.12), respectively. A caregiver’s unmet needs (r = −0.272, p < 0.001) and depression (r = −0.279, p < 0.001) were negatively related to a care recipient’s QoL. Depression among caregivers played a mediating role in the relationship between a caregiver’s unmet needs and a care recipient’s QoL. As nursing interventions address depression among caregivers, it is important to standardize the programs that offer psychological support to caregivers.

Challenges in the Management of Childhood Cancer Patients in a Tertiary Hospital in Southern Nigeria

Introduction: The burden of childhood cancer is an important child health concern globally. Several million new cases are diagnosed annually, but the greatest burden is borne by developing countries. The management of paediatric cancer patients in these settings is fraught with several challenges, which can significantly affect outcome.&#x0D; Aim: To identify the various challenges in management of children with cancers in the University of Uyo Teaching Hospital Uyo, Nigeria and proffer interventions which may impact positively on their long term survival and quality of life.&#x0D; Methods: A three year retrospective study of children admitted with cancers was carried out at the Haemato-Oncology unit of the department of Paediatrics, University of Uyo Teaching Hospital, Uyo Nigeria, from January 2019 and December 2021. The available records of their admission, treatment process, progress and outcome were reviewed.&#x0D; Results: Of the thirty-eight (38) patients seen, all presented at a late stage of disease. The socio-economic class of parents were mostly low (81.6%) and all treatments were self-sponsored, with 44.7% discharging against medical advice due to financial constraints.&#x0D; Conclusion: The challenges in the management of paediatric cancer patients included late presentation, late diagnosis, financial constraints/poverty, burn-out of caregivers, with a resultant high frequency of discharge against medical advice. Greater awareness about childhood cancers, increased advocacy for governmental input by way of resources, infrastructure and health insurance policies would improve outcome.

Global, Regional, and National Burden of Cancer in Children Younger Than 5 Years, 1990-2019: Analysis of the Global Burden of Disease Study 2019.

ObjectivesTo quantify the burden and variation trends of cancers in children under 5 years at the global, regional, and national levels from 1990 to 2019.MethodsEpidemiological data for children under 5 years who were diagnosed with any one childhood cancer were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2019. The outcomes were the absolute numbers and rates of incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for different types of cancer.ResultsIn 2019, 8,774,979.1 incident cases (95% uncertainty interval [UI]: 6,243,599.2 to11,737,568.5) and 8,956,583.8 (6,446,323.9 to 12,364,520.8) prevalent cases of cancer in children under 5 years were identified worldwide; these cancers resulted in 44,451.6 (36,198.7 to 53,905.9) deaths and 3,918,014.8 (3,196,454.9 to 4,751,304.2) DALYs. From 1990 to 2019, although the numbers of incident and prevalent cases only decreased by −4.6% (−7.0 to −2.2) and −8.3% (−12.6 to −3.4), respectively, the numbers of deaths and DALYs clearly declined by −47.8% (−60.7 to −26.4) and −47.7% (−60.7 to −26.2), respectively. In 2019, the middle sociodemographic index (SDI) regions had the highest incidence and prevalence, whereas the low SDI regions had the most mortality and DALYs. Although all of the SDI regions displayed a steady drop in deaths and DALYs between 1990 and 2019, the low-middle and low SDI regions showed increasing trends of incidence and prevalence. Leukemia remained the most common cancer globally in 2019. From 1990 to 2019, the burdens of leukemia, liver cancer, and Hodgkin's lymphoma declined, whereas the incidence and prevalence of other cancers grew, particularly testicular cancer.ConclusionsThe global childhood cancer burden in young children has been steadily decreasing over the past three decades. However, the burdens and other characteristics have varied across different regions and types of cancers. This highlights the need to reorient current treatment strategies and establish effective prevention methods to reduce the global burden of childhood cancer.

Global, regional, and national childhood cancer burden, 1990–2019: An analysis based on the Global Burden of Disease Study 2019

IntroductionCancer is the leading cause of death among children. ObjectivesWe report on the latest estimates of the burden of cancer among children at the global, regional, and national levels from 1990 to 2019. MethodsBased on the Global Burden of Disease Study 2019, children’s cancer data were analyzed by sex, age, year, and location. Age-standardized rates were used to compare the burdens among regions and nations. Joinpoint analysis was applied to assess the temporal trend of the global childhood cancer burden. ResultsIn 2019, 291,319 (95% uncertainty interval [UI], 254,239 to 331,993) new cases and 98,834 (86,124 to 113,581) deaths from childhood cancer were documented globally. Further, 8,302,464 (7,230,447 to 9,555,118) DALYs and 1,806,630 (1,567,808 to 2,089,668) prevalent cases were recorded in the same year. Age-standardized incidence and prevalence rates of childhood cancer were greatest in higher SDI settings and increased most significantly in Australasia and Southern Latin America over the last 30 years. However, although age-standardized death and DALY rates of childhood cancer have remarkably decreased in all regions since 1990, countries with a lower SDI showed the highest rates in 2019, particularly in countries in Eastern Sub-Saharan Africa. Among all cancers, leukemia has shown the largest decrease in burden since 1990. Despite this, leukemia was still the most common cancer and the leading cause of death among children in 2019, followed by brain and central nervous system cancer. ConclusionsOn a global scale, the childhood cancer burden has significantly fallen over the last 30 years, but is still higher in lower SDI countries. Effective interventions and collaborations among nations should be facilitated to improve healthcare among children with cancer in countries with lower SDI.

Estimated incidence, prevalence, mortality, and registration of childhood cancer (ages 0–14 years) in the WHO Eastern Mediterranean region: an analysis of GLOBOCAN 2020 data

There is little evidence about childhood cancer burden in the WHO Eastern Mediterranean region (EMR). We aimed to provide an estimate of childhood cancer burden in the EMR, examine the connection between age-standardised mortality rate and level of income (gross domestic product [GDP] per capita), and reflect on the current status of childhood cancer registration in the EMR. Using the GLOBOCAN 2020 data from the Cancer Surveillance Unit of the International Agency for Research on Cancer, we extracted data for childhood cancer (at ages 0-14 years) incidence, prevalence, and mortality for 22 countries in the EMR, the EMR as a whole, and other WHO regions, and categorised by main cancer types. Childhood cancers were classified according to the 10th revision of the International Classification of Diseases. We also searched MEDLINE, Google Scholar, and the grey literature between May 17 and Aug 2, 2021, for English-language articles and reports about the status of childhood cancer registration in the EMR. We further examined the connection between age-standardised mortality rate and GDP per capita for the 22 countries in the EMR. The total estimated number of incident childhood cancer cases in the EMR was 23 847 in 2020, with an age-standardised incidence rate of 10·1 per 100 000 children at risk, ranging from 7·3 per 100 000 children at risk in Pakistan to 13·8 per 100 000 children at risk in Iran. The estimated number of incident cases was 7451 (age-standardised incidence rate 3·10 per 100 000 children at risk) for leukaemia, 3006 (1·30 per 100 000 children at risk) for brain and CNS tumours, 2222 (0·92 per 100 000 children at risk) for non-Hodgkin lymphoma, 1569 (0·67 per 100 000 children at risk) for kidney cancers, and 1420 (0·58 per 100 000 children at risk) for Hodgkin lymphoma. In 2020, the number of total estimated childhood cancer deaths in the EMR was 10 535, with an age-standardised mortality rate of 4·4 (per 100 000 children at risk, ranging from 0·8 per 100 000 children at risk in Qatar to 7·2 per 100 000 children at risk in Somalia. A negative correlation was found between countries' GDP per capita (income level) and mortality rates (r=-0·77, p<0·0001). The scarcity of data and quality of cancer registries in EMR countries prevented further analysis. Given the variable quality and coverage of cancer registries in EMR countries, these findings are likely to be underestimates. Nevertheless, these data, especially the high mortality rates, reflect a need for effective national childhood cancer plans in line with the WHO Global Initiative for Childhood Cancer to improve survival. Friends of Cancer Patients.

Rare Childhood Cancer Burden in a Tertiary Care Hospital of Dhaka, Bangladesh

Background: Accurate childhood cancer burden data are crucial for resource planning and health policy prioritization. In Bangladesh we have no national population based cancer registry. Data about the total burden of childhood cancer in our country is unknown. But a hospital based cancer registry is the cheapest way to assess the tumor burden of a nation. So we investigate the total pediatric cancer burden and the percentage of different types of rare childhood cancers (RCC) of National Institute of Cancer Research and Hospital (NICRH), Dhaka, during the year 2014 – 2018. Aim: To investigate the total number of pediatric cancers, frequency of different types of rare cancer and percentage of rare childhood cancer in the Pediatric Hematology and Oncology (PHO) department. Methods: Data were collected from all pediatric (0-17 years) patients between the year 2014 and 2018 prospectively. Definitive diagnosis of cases were established by histopathological and or immunohistochemical study. As we have no population-based cancer registry, we considered the rare tumors in our study according to the Children's Oncology Group (COG) and the German Childhood Cancer Registry (GCCR). Results: Total number of childhood cancers and RCC was 2242 and 351 respectively. Percentage of rare tumors was 15.66% in our center. Benign rare tumors were 18.52% (N-65) cases. Common age group was the 5-9 years group (54.13 %). Most common RCC groups were Non-Rhabdomyosarcoma soft tissue sarcoma (NRSTS) constituting 49.29 %, followed by Malignant epithelial neoplasms and melanomas (38.18%). Diagnostic delay was 3.52 months. Most common malignancy was Synovial Sarcoma (N-40, 11.39%), Peripheral Neuroectodermal Tumor (N-39, 11.11%), Nasopharyngeal carcinoma (N-35, 9.97%), Malignant small round cell tumor (N-31, 8.83%) and Carcinoma rectum and colon (N-23, 6.55%). Conclusion: We have found that our Institutional (NICRH) rare tumor rate (15.66%) was a bit higher than US national RCC (15%). Though Institutional cancer data reflect the national burden, to estimate the accurate number and percentage of RCC, National Cancer Registry is needed.

Medical Cost of Cancer Care for Privately Insured Children in Chile.

Medical care for children with cancer is complex and expensive, and represents a large financial burden for families around the world. We estimated the medical cost of cancer care for children under the age of 18, using administrative records of the universe of children with private insurance in Chile in the period 2007–2018, based on a sample of 3853 observations. We analyzed total cost and out-of-pocket spending by patients’ characteristics, type of cancer, and by service. Children with cancer had high annual medical costs, USD 32,287 on average for 2018. Costs were higher for the younger children in the sample. The vast majority of the cost was driven by inpatient hospital care for all types of cancer. The average total cost increased 20% in real terms over the period of study, while out-of-pocket expenses increased almost 29%. Private insurance beneficiaries faced a significant economic burden associated with medical treatment of a child with cancer. Interventions that reduce hospitalizations, as well as systemwide reforms that incorporate maximum out-of-pocket payments and prevent catastrophic expenditures, can contribute to alleviating the financial burden of childhood cancer.

Estimated National and State Level Incidence of Childhood and Adolescent Cancer in India

Hitherto, incidence burden of childhood cancer in India has been derived from GLOBOCAN data. Recent analyses have challenged whether this accurately measures the true incidence of childhood cancer. To use observed data rather than simulation to estimate the number of children (0-14 years), as well as number of children and adolescents (0-19 years), in India who develop cancer every year at the national and state/union territory (UT) level. Age-specific (five year groups), sex-specific, and state/UT specific population data from India Census 2011 was used. Global average incidence rates from the International Incidence of Childhood Cancer 3 (IICC3) report were used. Incidence rates per million person-years for the 0-14 years and 0-19 years age groups were age-adjusted using the world standard population to provide age-standardized incidence rates, using the age-specific incidence rates for individual age groups (0-4 years, 5-9 years, 10-14 years, and 15-19 years). The national number of children (0-14 years) and, children and adolescents (0-19 years) that may develop cancer every year based on 2011 census are 52,366 and 76,805 persons respectively. Cancer type specific incidence is provided for each state/UT for these age ranges. This national incidence is approximately double of the GLOBOCAN 2018 estimates of incidence of children diagnosed and registered with cancer and the differential is greater in girls. Our analysis proposes new estimates of incident childhood cancer cases in India for children and adolescents. Future regional, national and international research on childhood cancer epidemiology and healthcare accessibility would help further refine these estimates.