By Emma Rifat, The Bryn Mawr School, Baltimore, MD
The inequity of global wealth disparity, an impediment in the efforts towards cultivating a healthcare system devoid of geographic and monetary setbacks, is evident when looking through the lens of pediatric cancer.
Childhood cancer is a global phenomenon, and it has prevailed as one of the leading causes of death among children and adolescents. According to the World Health Organization, approximately 300,000 children, ages 0-19, are diagnosed with cancer each year. However, the statistical probability of survival increases with early diagnosis and effective treatment (WHO, 2018). This ounce of hope for pediatric cancer patients and their families comes with the burden of an expensive price. In the broader context of the world, childhood cancer treatment is a luxury for those lucky enough to receive it.
As the technological capabilities of our modern world advance expeditiously—fostering essential growth in pediatric oncology—only certain countries within the global network are reaping the benefits. High-Income Countries (HICs), those with a gross national income per capita that exceeds $12,056, have the upper hand in providing accessible and strategic treatment to most childhood cancer patients (High Income Countries, 2020).
On the other hand, many Low and Middle-Income Countries (LMICs) struggling with poverty are in desperate need of funding, expertise, and public health infrastructure (St. Jude’s Research Hospital, 2018). The National Institute of Health approximates that, in HICs, 80% of children diagnosed with cancer are cured as compared to only 20% of patients in LMICs (WHO, 2018). Wealth should not be a proprietor of life. Children living in low-middle income countries that vary in functionality and financial stability are met with lower survival rates, lack of accurate diagnosis, death from toxicity (side effects), relapse due to a scarcity of imperative medicines and technologies, and abandonment of treatment (WHO, 2018). In simpler terms, money equates to the likelihood of recovery.
To realistically defeat cancer in LMICs, scientists must maximize the efficiency of treatments. Luckily, there are some instances of these cost-effective treatments. For example, Burkitt Lymphoma, the most common childhood malignancy in Sub-Saharan Africa, is cured 90% of the time in HICs with intensive regimens (Gupta et al., 2015). However, up to 50% of African children with the same disease can recover with just three to six doses of a chemotherapy drug, cyclophosphamide, and intrathecal therapy—injections into the spine (Gupta et al., 2015).
Defeating cancer in LMICs is heavily dependent on external resources. Initiatives such as the My Child Matters (MCM) program are working diligently to improve pediatric cancer treatment in developing countries by providing financial support, aid and guidance from international experts, and in-country networking for project developers (My Child Matters, 2020). In 2013, the NIH conducted a study in ten LMICs receiving My Child Matters support—Bangladesh, Egypt, Honduras, Morocco, Philippines, Senegal, Tanzania, Ukraine, Venezuela, and Vietnam. The project aimed to assess the level of competency based on access to health professionals, resources, and medicine (Ribeiro et al., 2013). Data from the study demonstrated poor or limited availability of medication, radiotherapy, and blood products across eight of the ten countries, with only adequate availability in the two remaining countries (Ribeiro et al., 2013). In addition, the attainability of diagnostic testing was presumed poor or limited in 80% of countries due to the paucity of modern imaging and other diagnostic technologies. More than half of the countries did not even have enough pediatric-cancer units or beds to accommodate all patients (Ribiero et al., 2013). This study conclusively determined that the overall management of pediatric cancer within the ten LMICs is substandard; it is apparent that the advancements of modern medicine have failed to reach those in the most dire circumstances.
Last summer, I had the opportunity to shadow pediatric oncologist Dr. Llosa, a specialist studying the immunotherapy of sarcoma tumors at Johns Hopkins University. From the painstaking work of the lab technicians harvesting fresh sarcoma tumors from recent surgeries to the packed table of experts analyzing the case of each patient, I experienced an awakening. That a patient would be supported by a determined team ready to take a leap of faith to fight this daunting battle seemed insured. I now realize the disheartening reality of the difference in treatment that wealth disparity has inflicted on pediatric cancer victims globally.
Despite this, we must be motivated to seek reform. Twinning partnerships that pair HICs with LMICs are inspiring change, as is MCM, and the WHO Global Initiative for Childhood Cancer. It is crucial that we establish strong relationships between multidisciplinary teams around the world, encourage planning on the part of policy makers, and devise model-based estimates in countries that lack data (NCI, 2020; GBD 2017 Childhood Cancer Collaborators, 2017). Awareness is key. Hope is strength. Action is power. Overcoming the hurdle of global cancer disparity is a feat for all of humanity.
References
For Children with Retinoblastoma, Disparities Seen across the Globe. (2020, March 12). National Cancer Institute. Retrieved August 12, 2020 from https://www.cancer.gov/news-events/cancer-currents-blog/2020/retinoblastoma-global-disparities-low-middle-income-countries
GBD 2017 Childhood Cancer Collaborators. The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017 [published correction appears in Lancet Oncol. 2019 Aug 6;:]. Lancet Oncol. 2019;20(9):1211-1225. doi:10.1016/S1470-2045(19)30339-0
Gupta S., et al. (2015). Treating Childhood Cancer in Low- and Middle-Income Countries. Cancer: Disease Control Priorities. Third Edition. Vol. (3), chapter 7. 10.1596/978-1-4648-0349-9_ch7
High Income Countries. (n.d). World Population Review. Retrieved August 12, 2020, from https://worldpopulationreview.com/country-rankings/high-income-countries
My Child Matters. (n.d). International Society of Pediatric Oncology. Retrieved August 12, 2020, from https://siop-online.org/project/mychildmatters/
Ribeiro, R.C, et al. (2013). Baseline status of paediatric oncology in ten low-income or mid-income countries receiving My Child Matters support: a descriptive study. Lancet Oncol. 2008 Aug; 9(8): 721–729. 10.1016/S1470-2045(08)70194-3
St. Jude’s Research Hospital. (2018, September 27). Global Disparities in Childhood Cancer. [video file]. Retrieved from https://www.youtube.com/watch?v=zlLnjfZNXRg
World Health Organization. (2018, September 28). Cancer in Children. Retrieved from https://www.who.int/news-room/fact-sheets/detail/cancer-in-children
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Magrath, I, et al. (March 2013). African children with Burkitt’s lymphoma [photograph]. The Lancet Oncology. https://www.sciencedirect.com/science/article/pii/S1470204513700081
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