Catherine G. Lam

Background: In recent decades, significant improvements have been made in the treatment of many childhood and adolescent cancers (patients ages 0–19 years), yet outcomes remain strikingly inequitable worldwide. We quantified the 2024 global burden of childhood and adolescent cancer by Human Development Index (HDI) and projected trends to 2050. Methods: We used GLOBOCAN 2024 to estimate numbers of children and adolescents diagnosed with cancer and who died from cancer in 186 countries, overall and for four key cancer types (leukemia, brain and central nervous system [CNS] tumors, non‐Hodgkin lymphoma [NHL], and kidney cancer). Age‐standardized incidence and mortality rates (ASIR, ASMR) were calculated using the Segi–Doll world standard and stratified by sex, UN region, and four‐tier HDI. Projections to 2050 applied 2024 age‐specific rates to UN World Population Prospects demographic estimates, assuming constant rates over time. Results: In 2024, excluding non‐melanoma skin cancer, an estimated 277,023 children and adolescents were diagnosed with cancer and 102,056 died from cancer. Leukemia accounted for 27.8% of diagnoses and 33.9% of deaths, followed by CNS tumors (11.1% of diagnoses; 17.3% of deaths), NHL (8.2%; 6.9%), and kidney cancers (4.7%; 2.5%). Hematological malignancies represented the largest diagnostic category across all HDI levels, accounting for 36.8–46.4% of incident cases and 35.9–49.5% of deaths. Very high‐HDI countries had the highest ASIRs but the lowest ASMRs, whereas low‐ and medium‐HDI settings accounted for 57% of deaths in 2024. By 2050, incident cancers are projected to increase by 35.2% and deaths by 34.8% in low‐HDI countries, while very high‐ and high‐HDI countries are projected to experience relative declines in both incidence and mortality. Approximately 52% of diagnoses and 65% of deaths are expected in low‐ and medium‐HDI countries, with more than 35% of deaths occurring in low‐HDI settings alone. Interpretation: Although significant advances have improved outcomes of many childhood and adolescent cancers, substantial global disparities in cancer burden persist. Underdiagnosis, limited diagnostic infrastructure, constrained workforces, and weak cancer registration systems likely lead to underestimation of the true burden. Under the assumption of constant incidence and mortality rates, an increasing share of childhood and adolescent cancer cases and deaths is projected to occur in low‐ and medium‐HDI countries, underscoring the need for equitable investments in diagnosis, treatment, survivorship, and cancer registration. Contextualized implementation of the WHO Global Initiative for Childhood Cancer, including earlier diagnosis, reliable access to essential therapies, survivorship care, and strengthened registries, is essential to ensure that all children, regardless of geography, have a chance to survive cancer and thrive.

Background: Strengthening health systems in low-and middle-income countries (LMICs) like Nepal is essential for equitable, high-quality diagnosis and treatment and improved survival from childhood cancer. This study aims to quantify care intervals and their determinants; assess the quality of care and 1-, 2-, and 3-year survival; quantify the costs and cost burden of childhood cancer treatment from family and health system perspectives; and to assess the capacity of health systems in Nepal to diagnose and treat children with cancer. Methods: This three-year prospective cohort study will enrol and follow consecutive childhood cancer patients aged 0-19 years registered at six tertiary hospitals in Nepal, accounting for approximately 90% of childhood cancer cases diagnosed nationally. After obtaining informed consent and assent, a semi structured questionnaire will be administered to patient/caregiver at baseline and every three months during the first year and every six months in the second and third years. Patient/caregiver data will be supplemented with patients’ medical records kept in the hospital. A national capacity assessment will assess readiness for childhood cancer care in tertiary-level and secondary-level healthcare facilities involved in referral, diagnosis, treatment or shared care. Survival outcomes will be examined using Cox proportional hazards models and random effects models to account for hospital clustering. Out-of-pocket costs will be analysed using descriptive statistics and a two-part regression model to account for zero-inflated cost distributions, with five-year health system cost projections modelled to estimate corresponding rates of catastrophic health expenditure and medical impoverishment. Discussion: This study will generate comprehensive evidence on childhood cancer care, costs, and health system capacity for care in Nepal. Findings will directly inform policy guidance, resource allocation and benefit package design for childhood cancer care in Nepal, inform comparable efforts in other low- and middle-income countries (LMICs), and will contribute to Nepal’s efforts in the WHO Global Initiative for Childhood Cancer towards improved cancer outcomes.

Febrile neutropenia (FN) is a frequent and serious complication in children receiving cancer therapy. Standardizing FN management across Asia is challenging due to variable healthcare infrastructure, diagnostic capacity, and infection patterns; however, it could improve resource use and patient outcomes. A multidisciplinary panel, including patient advocates from 10 countries developed a clinical practice guideline (CPG) for FN using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The final CPG contains 25 recommendations addressing regional priorities in diagnosis, risk stratification, and management. This CPG creates a regional standard to be tailored and studied in local context.

PURPOSE: Palliative care (PC) integration in pediatric oncology improves outcomes, yet access to PC in the Asia Pacific (AP) region remains limited. This study aimed to understand physician perceptions of PC integration in childhood cancer care across AP. METHODS: The validated Assessing Doctors' Attitudes on Palliative Treatment survey was modified for use in AP, translated into six languages, and adapted for cultural relevance. The survey was distributed electronically between February 2022 and February 2024 to physicians caring for children with cancer in 18 AP countries. The primary outcome was alignment with WHO PC guidance, calculated as a mean percentage per physician. Secondary analyses explored associations between demographic variables and WHO alignment scores using regression analyses. Open-ended responses were analyzed qualitatively. RESULTS: A total of 621 physicians from 18 countries participated (median country response rate 30%; range, 11%-85% per country). Most (70%; n = 432) had >10 years of clinical experience and no prior PC training (65%; n = 401). Although 57% (n = 352) had access to pediatric PC experts, only 50% (n = 308), 36% (n = 221), 27% (n = 166), and 34% (n = 209) expressed comfort addressing patient/family physical, emotional, spiritual, and grief/bereavement needs, respectively. Additionally, 40% (n = 248) reported feeling burdened addressing end-of-life suffering. The mean alignment with WHO guidance was 76% (range, 48%-92%). Almost all (>90%; n = 570) desired further PC training. CONCLUSION: Study findings demonstrate that most physicians in AP expressed discomfort with providing core components of PC to patients with cancer and their families. This study signals the urgent need for focused expansion of PC services and training and identifies regional opportunities to improve PC education, research, and advocacy efforts.

PURPOSE: Early integration of palliative care (PC) for children with cancer is vital to improved patient outcomes. Despite this, access to PC services for children in Asia Pacific (AP) is sparce. We aimed to explore potential barriers to PC provision in childhood cancer care across AP. METHODS: The Assessing Doctors' Attitudes on Palliative Treatment survey was revised for cultural context, translated into six languages, and distributed electronically to physicians who care for children with cancer. Descriptive statistics were used to summarize data. Secondary analyses used the Pearson chi-square test or Fisher exact test to examine associations between prior PC training and physician subspecialty with reported barriers. The McNemar test was applied to evaluate differences between actual versus ideal timing of PC consultations. Analysis of variance was conducted to compare mean values for perceived barriers across country income levels. RESULTS: Six hundred twenty-one physicians from 18 countries participated, with an overall response rate of 27% (621/2,305) and a median country response rate of 30% (range, 11%-85%). Most respondents (n = 366; 59%) believed PC should be consulted at diagnosis, but only 18% (n = 117) stated that this occurred in their clinical setting ( P < .001). The most highly ranked barriers to PC provision included limited physician knowledge (n = 511; 82%), lack of national health policy/advocacy (n = 494; 79%), lack of PC-trained clinicians (n = 492; 79%), lack of home-based services (n = 487; 78%), and physician discomfort in discussing PC (n = 483; 78%). Physicians practicing in lower-middle–income countries rated these barriers more significantly. CONCLUSION: Physicians report a discrepancy between ideal and actual timing of PC integration and identify several barriers to PC provision. Study findings will inform capacity building, education, and advocacy initiatives to improve the timing and quality of PC delivery in the region.

PURPOSE: The International Agency for Research on Cancer and St Jude Children's Research Hospital established Targeting Childhood Cancer through the Global Initiative for Cancer Registry Development, a collaboration to accelerate change in childhood cancer registration in selected countries. We summarize the overall situation of the first 5-year implementation period highlighting key commonalities and challenges encountered. METHODS: Following the Global Initiative for Cancer Registry Development model, Georgia, Mexico, South Africa, and Vietnam were selected as implementation sites. We established a team per country, assessed the general and childhood cancer registration situation, and implemented targeted support via online meetings and site visits. Multimodal situational assessments were organized in four domains: Context, Governance, Procedures, and Dissemination. Key challenges were identified in each domain and mapped to critical attributes for evaluating surveillance systems. RESULTS: The scope, modalities, and coverage of cancer registration across countries vary in important ways; only South Africa has a specific childhood cancer registry. Not all registries in the four countries included nonmalignant tumors of the CNS, reported cancers using the childhood cancer-specific system International Childhood Cancer Classification third edition, or reported any survival information. Common challenges identified in all four countries included irregular financial support, instability in personnel, and difficulties in access and data sharing; none had an advisory committee. These challenges affect sustainability and data quality. CONCLUSION: Partnerships are valuable to accelerate change but take time to consolidate before impact is observed. Childhood cancer surveillance needs definitive support as a key component of the WHO Global Initiative for Childhood Cancer.