An analysis led by St. Jude Children’s Research Hospital has for the first time looked at the global burden of pediatric cancer through the lens of years of affected and lost life. This work shows a much greater burden of childhood cancer, placed largely in low- and middle-income countries, than previous estimates. The work appears as an advance online publication today in Lancet Oncology.
By using disability-adjusted life years (the sum of years of life lost and years lived with disability) to represent the burden of childhood cancer for the first time, the researchers can compare cancer to other pediatric diseases like HIV or tuberculosis. In childhood cancer, early deaths lead to many years of life lost, and survivors often live for extended periods with chronic disability. These affected years of life are captured when evaluating disability-adjusted life years but are not highlighted by traditional incidence and mortality data.
This new method for assessing global childhood cancer burden will help experts plan resources and set health policy priorities. Additionally, an understanding of disability-adjusted life years may help local governments, stakeholder groups and the global health community identify disease priorities and focus cancer control efforts.
“Previous estimates using incidence and mortality cases put the burden of childhood cancer in the hundreds of thousands globally,” said Nickhill Bhakta, M.D., of the St. Jude Department of Global Pediatric Medicine. “By looking at a different metric, disability-adjusted life years, we can now show for the first time that the burden of disease due to childhood cancer is significant and underappreciated in both the cancer and child health communities.”
In July 2018, St. Jude and the Institute for Health Metrics and Evaluation at the University of Washington announced a partnership to improve global childhood cancer burden estimates. This effort leverages both organizations’ expertise in health metrics sciences and childhood cancer care to provide more accurate estimates of the global burden of cancer among children. The Institute for Health Metrics and Evaluation runs the annual Global Burden of Disease study, which provides estimates for 359 diseases and injuries, including cancers, with more than 3,000 collaborators in nearly 150 countries and territories. A global, collaborative effort, the Global Burden of Disease study provides critical estimates for countries to help improve their health care efforts.
The St. Jude analysis is built upon data collected through the Global Burden of Disease 2017 study, with childhood cancer burden estimates represented by disability-adjusted life years providing a comprehensive and comparable framework for assessing and contextualizing pediatric cancer. The results show that globally in 2017, there were approximately 11.5 million disability-adjusted life years due to childhood cancer, 97.3% of which were attributable to years of life lost.
The social and economic burden of childhood cancer is most prominent in countries on the lower end of the development spectrum, largely in Asia, Africa and Central and South America, which experience 82.2% of all childhood cancer disability-adjusted life years.
“While global incidence and mortality estimates are available, there are no prior analyses of the global burden of childhood cancer represented by disability-adjusted life years,” said first and corresponding author, Lisa Force, M.D., of the St. Jude Department of Global Pediatric Medicine. “This analysis shows that childhood cancer results in substantial disease burden despite a relatively low absolute number of incident cases and deaths.”
Worldwide, more than 90% of children with cancer live in low- and middle-income countries. Many of these children lack access to adequate diagnosis and treatment. In September 2018, St. Jude and World Health Organization announced a five-year collaboration aimed at transforming childhood cancer care worldwide to cure at least 60% of children with six common types of cancer by 2030. The perspective provided by the analysis of disability-adjusted life years from the Global Burden of Disease 2017 study will aid in St. Jude Global’s efforts to give children with cancer access to quality care no matter where they live.
Led by the Department of Global Pediatric Medicine, St. Jude Global is dedicated to the sharing of knowledge, technology and organizational skills to change the tide against pediatric cancer. St. Jude Global is creating a network of institutions collaborating to form a global alliance, which includes regional programs in Asia-Pacific, Central and South America, China, the East and Mediterranean, Eurasia, Mexico and Sub-Saharan Africa.
The study’s other authors include Christina Fitzmaurice, M.D., of the University of Washington, as well as more than 130 members of the Global Burden of Disease 2017 Childhood Cancer Collaboration.
The research was funded in part by the Bill & Melinda Gates Foundation, St. Baldrick’s Foundation and ALSAC, the fundraising and awareness organization of St. Jude.
Read the full text of the article:
Lancet Oncology. Published online: July 29, 2019.