Global childhood cancer survival estimates and priority-setting: A simulation-based analysis
Open accessAbstract
Background Accurate childhood cancer survival estimates are crucial for policy makers and clinicians for priority-setting and planning decisions. However, observed survival estimates are lacking for many countries, and when available, wide variation in outcomes is reported. Understanding the barriers to optimising survival can help improve childhood cancer outcomes. We aimed to provide estimates of global childhood cancer survival, accounting for the impact of multiple factors that affect cancer outcomes in children.Methods We developed a microsimulation model to simulate childhood cancer survival for 200 countries and territories worldwide, accounting for clinical and epidemiologic factors, including country-specific treatment variables, such as availability of chemotherapy, radiation, and surgery. To ensure model results were consistent with reported survival data, we calibrated the model to estimates from the CONCORD-2 and CONCORD-3 studies using an Approximate Bayesian Computation approach. We estimated 5-year net survival for diagnosed cases of childhood cancer in each country and territory and estimated potential survival gains of seven policy interventions focused on improving treatment availability and delivery (ie, increasing the availability of chemotherapy, radiation, general surgery, neurosurgery, or ophthalmic surgery, reducing treatment abandonment, and improving the quality of care to the mean of high-income countries) implemented in isolation or as packages.Findings Our model estimated that, for diagnosed cases, global 5-year net childhood cancer survival is currently 37·4% (95% uncertainty interval 34·7-39·8), with large variation by region, ranging from 8·1% (4·4-13·7) in eastern Africa to 83·0% (81·6-84·4) in North America. Among the seven policy interventions modelled, each individually provided small gains, increasing global 5-year net survival to between 38·4% (35·8-40·9) and 44·6% (41·7-47·4). 5-year net survival increased more substantially when policy interventions were bundled into packages that improved service delivery (5-year net survival 50·2% [47·3-53·0]) or that expanded treatment access (54·1% [50·1-58·5]). A comprehensive systems approach consisting of all policy interventions yielded superadditive gains with a global 5-year net survival of 53·6% (51·5-55·6) at 50% scale-up and 80·8% (79·5-82·1) at full implementation.Interpretation Childhood cancer survival varies widely by region, with especially poor survival in Africa. Although expanding access to treatment (chemotherapy, radiation, and surgery) and addressing financial toxicity are essential, investments that improve the quality of care, at both the health-system and facility level, are needed to improve childhood cancer outcomes globally.Funding Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard TH Chan School of Public Health, Harvard Medical School, National Cancer Institute, SickKids, St Jude Children's Research Hospital, Union for International Cancer Control, Children with Cancer UK Davidson and O'Gorman Fellowship.
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Significant improvements in childhood cancer treatments have resulted in growing numbers of young survivors worldwide.
“Significant improvements in childhood cancer treatments have resulted in growing numbers of young survivors worldwide [1,2].”
From Providing psychological support to parents of childhood cancer survivors: ‘cascade’ intervention trial results and lessons for the future (2021) · cites this paper as [1]
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- Authors
- Ward, Z. J., Yeh, J. M., Bhakta, N., Frazier, A. L., Girardi, F., & Atun, R.
- Affiliations
- Harvard University (US)
- Boston Children's Hospital (US)
- St. Jude Children's Research Hospital (US)
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center (US)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Ward, Zachary J
- Venue
- The Lancet Oncology
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 20
- Issue
- 7
- Pages
- 972-983
- ISSN
- 1470-2045 (ISSN-L)
- OpenAlex
- W2944851513
- Cited by
- 277
- References
- 30
- Citations by year
- 2026: 34 · 2025: 61 · 2024: 42 · 2023: 58 · 2022: 37 · 2021: 21 · 2020: 21 · 2019: 3
- FWCI
- 8.66
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- The Lancet Oncology (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Harvard Dataverse
- Topics
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advances in Oncology and Radiotherapy
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Keywords
- childhood cancer survival, priority setting, health policy interventions, treatment access, neurosurgery, ophthalmic surgery, treatment discontinuation, quality of care, microsimulation model, approximate Bayesian computation, net survival, health system strengthening, health equity
- MeSH terms
- Child, Computer Simulation, Delivery of Health Care, Health Priorities, Humans, Neoplasms, Statistics as Topic, Global Health, Survival Rate
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