Emergence of cancer as a major cause of death among children in developing regions of the world is not being adequately addressed

May 29 2005

The emergence of cancer as a major cause of death among children in developing regions of the world is not being adequately addressed by national or international health organizations and charities, according to investigators at St. Jude Children's Research Hospital. This growing rate of pediatric cancer is occurring as the number of children dying from infectious diseases is being reduced through the efforts of the World Health Organization and international charities, the researchers say.

Health care organizations and charities have traditionally focused on relatively inexpensive strategies for combating infectious diseases, said Ching-Hon Pui, M.D., director of the Leukemia/Lymphoma Division at St. Jude and American Cancer Society F.M. Kirby clinical research professor. This decision has left many children with cancer in much of the developing regions of Asia, South and Central America, Africa, and the Middle East without access to effective medical treatment, he added. Pui is a co-author of an editorial on the geographical inequality of pediatric cancer treatment that appears in the May 26 issue of the New England Journal of Medicine.

"More than 60 percent of the world's children have little or no access to effective cancer therapy," Pui said. "And their survival rates are very inferior to rates in countries with advanced health care systems. However, the World Health Organization and many international charities don't even list chronic diseases, including cancer, as health priorities on their agendas."

The increasing pediatric cancer death rate in countries with limited resources is especially tragic because strategies exist that could be used to ensure wider access to effective cancer treatment, according to Raul C. Ribeiro, M.D., director of the St. Jude International Outreach Program and another co-author of the editorial. The authors note that one of the most effective strategies is a cooperative process between institutions, called twinning, which is already in place in Central and South America, Africa and Southeast Asia, thanks to the efforts of the International Society of Pediatric Oncology, several institutions in Europe and St. Jude Children's Research Hospital in the United States. St. Jude has already assisted several developing countries in significantly improving the cure rates of leukemia--the most common childhood cancer--as well as Burkitt lymphoma, Wilms tumor, Hodgkin disease and other curable malignancies.

"We've found that recruiting local oncologists to serve as program directors gives the best results," Ribeiro said. "The recruited oncologists serve as program directors, advocates of pediatric oncology units and coordinators of training for essential cancer care providers."

The authors argue that even the low level of development that exists in some parts of the world is not an insurmountable obstacle to establishing a productive twinning relationship. A program that concentrates on education, training and the treatment of the most responsive cancers could be effective. For example, in parts of Africa it might be possible to successfully treat children who have Burkitt's lymphoma using a single drug, cyclophosphamide. Such twinning projects can be supported initially by the partner in the more affluent country, the authors say. Local charitable groups can raise funds to support an oncology program.

Another benefit of twinning would be broadening the scope of cancer research to include cases in developing countries. This would facilitate studies of the roles that genetic background, environment and lifestyle play in susceptibility to cancer and pathogenesis of particular cancers. Such studies would be easier to conduct if pediatric cancer units are created in resource-poor nations and if their development promotes international cell and tissue banks and the ability to collect long-term treatment follow-up data.