Understanding the Global Landscape of Pediatric Cancers

CNBY 6

What percentage of pediatric cancers occur in non-high-income countries?

80-90% occur in low income, middle income and upper middle income countries

What is the estimated global incidence of pediatric cancer anually?

~400,000 to 470,000 cases/year

How many pediatric cancer cases were diagnosed vs estimated (example year)?

~224,000 diagnosed vs ~400,000 estimated → >40% underdiagnosis

Estimated pediatric cancer deaths globally?

~108,000–113,000 deaths/year

Why is pediatric cancer burden underestimated?

• Lack of registries

• Poor surveillance systems

• Limited diagnostic access

• Data collection gaps

Why do IARC and IHME estimates differ?

• Different number of registries

• Different country coverage

• Methodological differences

Why are cancer registries important?

• Track incidence

• Monitor outcomes

• Guide policy/resources

What initiative improves global cancer registry systems?

ChildGICR

Define Low income countries

≤ $1,135 GNI per capita

Define low middle income countries

$1,136–$4,495

Define Upper Middle Income Countries

$4,496–$13,935

Define High income countries

>$13,935

5-year survival in HICs?

~80%

5-year survival in LICs/LMICs?

<30%

Global average survival rate?

~37%

What determines survival more than biology?

Access to care, infrastructure, and resources

Most common pediatric cancers globally?

• Leukemia

• CNS tumors

• Lymphomas

Most common pediatric cancer?

ALL

Why are pediatric cancers misdiagnosed?

• Mimic malaria, TB

• Limited provider training

• Low awareness

% of misdiagnosis in Kenyan study?

~70%

Cultural barriers to diagnosis?

• Stigma

• Traditional healers

• No word for cancer in some cultures

Early signs of retinoblastoma?

• Leukocoria

• Strabismus

Retinoblastoma survival rates?

• HICs: ~98%

• LICs: ~57%

Advanced-stage diagnosis rates?

• LICs: 30–40%

• HICs: 2–5%

Financial impact on families in LMICs?

• Spend > monthly income

• Travel costs

• Lost wages

Effect of financial burden?

Treatment abandonment

% of trials in LMICs?

~28%

% of international trials?

~8.7%

% of intercontinental trials?

~5.4%

What is precision medicine?

Matching treatment to tumor genetics

% of patients with targetable mutations (example studies)?

Up to 70–90%

Types of modern treatments?

• Targeted therapy

• Immunotherapy

• Risk-adapted therapy

% of drugs that are targeted/immunotherapy?

~55%

ALL survival today in HICs?

>90%

Why did ALL outcomes improve?

• Risk stratification

• Genetic profiling

• Targeted therapy

Goal of GICC?

≥60% survival by 2030

CureAll pillars?

1. Centers of excellence

2. Universal health coverage

3. Standardized treatment

4. Monitoring

Key barriers to care?

• Drug shortages

• Lack of radiotherapy

• Delayed diagnosis

Ways to reduce treatment abandonment?

• Cash transfers

• Insurance

• Social support

Pediatric oncologist ratio in Africa?

0.35 per 1,000,000 children

Radiotherapy access comparison?

• Africa: 1 per 2.24M children

• US: 1 per 28,000

Neurosurgeon ratio Africa vs US?

• Africa: 1 per 304,685 children

• US: 1 per 15,468

% of African countries able to treat CNS tumors?

4/54 countries

Biggest concept to remember?

Survival differences = access, not biology

What is needed for global progress?

• Resource-adapted care

• Workforce expansion

• Data systems

• Global collaboration