Cancer is a leading cause of death for children and adolescents worldwide. In high-income countries more than 80% of children with cancer are cured, but in many low and middle income countries (LMICs) only 20% are cured.
The reasons for lower survival rates in LMICs include an inability to obtain an accurate diagnosis, inaccessible therapy, abandonment of treatment, death from toxicity (side effects), and excess relapse, in part due to lack of access to essential medicines and technologies. Addressing each of these gaps improves survival and can be highly cost-effective.
What causes cancer in children?
Cancer occurs in people of all ages and can affect any part of the body. It begins with genetic changes in a single cell that then grows out of control. In many cancers, this results in a mass (or tumour). If left untreated, cancer generally expands, invades other parts of the body and causes death.
Unlike cancer in adults, the vast majority of childhood cancers do not have a known cause. Many studies have sought to identify the causes of childhood cancer, but very few cancers in children are caused by environmental or lifestyle factors. Cancer prevention efforts in children should focus on behaviours that will prevent the child from developing preventable cancer as an adult.
Some chronic infections are risk factors for childhood cancer and have major relevance in low- and middle-income countries. For example, HIV, Epstein-Barr virus and malaria increase the risk of some childhood cancers. Other infections can increase the child’s risk of developing cancer as an adult, so it is important to be vaccinated and pursue other methods such as early diagnosis or screening to decrease chronic infections that lead to cancer, whether in childhood or later.
When identified early, cancer is more likely to respond to effective treatment and result in a greater probability of survival, less suffering, and often less expensive and less intensive treatment. Significant improvements can be made in the lives of children with cancer by detecting cancer early and avoiding delays in care.
Screening is generally not helpful for childhood cancers. In some select cases, it can be considered in high-risk populations.
A correct diagnosis is essential to treat children with cancer because each cancer requires a specific treatment regimen that may include surgery, radiotherapy, and chemotherapy. Access to effective diagnosis, essential medicines, pathology, blood products, radiation therapy, technology and psychosocial and supportive care are variable and inequitable around the world.
Palliative care relieves symptoms caused by cancer and improves the quality of life of patients and their families. Not all children with cancer can be cured, but relief of suffering is possible for everyone. Pediatric palliative care should be appropriately considered as a core component of comprehensive care starting when illness is diagnosed, and continued regardless of whether or not a child receives treatment with curative intent.