Global Initiative for Childhood Cancer

Cancer is a leading cause of death for children and adolescents, particularly in high-income countries.  The likelihood of surviving a diagnosis of childhood cancer depends on the country in which the child lives: in high-income countries, more than 80% of children with cancer are cured, but in many LMICs only 15-45% are cured.

The reasons for lower survival rates in LMICs include: delay in diagnosis and advanced disease, an inability to obtain an accurate diagnosis, inaccessible therapy, abandonment of treatment, death from toxicity (side effects), and avoidable relapse. Improving access to childhood cancer care, including to essential medicines and technologies, is highly cost effective, feasible and can improve survival in all settings.

Cancer occurs in people of all ages and can affect any part of the body. It begins with genetic change in single cells, that then grow into a mass (or tumour), invades other parts of the body and causes harm and death if left untreated. Unlike cancer in adults, the vast majority of childhood cancers do not have a known cause. Many studies have sought to identify the causes of childhood cancer, but very few cancers in children are caused by environmental exposure or lifestyle factors. Cancer prevention efforts in children should focus on behaviours that will prevent the child from developing preventable cancer as an adult. 

Some chronic infections, such as HIV, Epstein-Barr virus and malaria, are risk factors for childhood cancer. They are particularly relevant in LMICs. Other infections can increase a child’s risk of developing cancer as an adult, so it is important to be vaccinated (against hepatitis B to help prevent liver cancer and against human papillomavirus to help prevent cervical cancer) and to other pursue other methods such as early detection and treatment of chronic infections that can lead to cancer.

Current data suggest that approximately 10% of all children with cancer have a predisposition because of genetic factors. Further research is needed to identify factors impacting cancer development in children.

The goal is to give all children with cancer the best chance to survive, to live full and abundant lives and to live and die without suffering. Working across borders, sectors and disciplines, we can create a better future for children with cancer. 

In 2018, WHO launched, together with partners, the Global Initiative for Childhood Cancer, to provide leadership and technical assistance to governments to support them in building and sustaining high-quality childhood cancer programmes [4]. The goal is to achieve at least 60% survival for all children with cancer and reduce suffering, globally, by 2030. This represents an approximate doubling of the current cure rate and will save an additional one million lives over the next decade. The objectives of the Initiative are:

• to increase capacity of countries to deliver best practices in childhood cancer care; and
• to Increase prioritization of childhood cancer at the global, regional and national levels

The Cure All framework and its accompanying technical package are used have been developed to support implementation of the Initiative. The package is intended to help countries assess current capacity, set priorities, generate investment cases, develop evidence-based standards of care and monitor progress. An information-sharing portal has been created to facilitate sharing of expertise between countries and partners.  

Pillars:

• Centers of excellence and care networks with enough trained workers to deliver services;
• Universal health coverage for comprehensive and essential quality services;
• Regimens and roadmaps for diagnosis and treatment. These tailored plans will aid delivery of quality services through evidence-based technologies and medicines;
• Evaluation and monitoring. Robust information systems and research will ensure effective implementation, quality assurance and constant improvement.
   

Cross-cutting enablers:

• Advocacy
• Leveraged financing
• Linked governance

Children with cancer and their families are at the center of this Initiative, surrounded by stakeholders across sectors. Each is motivated to create an environment that will improve access to high-quality care. A core aim is to help governments and their partners to coordinate efforts and achieve this goal. This Initiative boasts more than 110 participating organizations and hundreds of global experts. They have agreed to help governments create strategic plans and priorities. We can succeed when leading academic centers, professional societies, parent groups, philanthropic foundations and the private sector come together with a shared goal. This Initiative and its partners have defined indicators to track progress and resources. 

Focus countries have resources available. They can help define national models and practical approaches to address needs in childhood cancer care. The result will be regional and global dialogues and global visibility. In focus countries, specific priorities are matched to contributions from partners across sectors. Select UN agencies have agreed to support the effort. These include WHO, the International Agency for Research on Cancer, the International Atomic Energy Agency, United Nations Children’s Fund, and the UN Development Programme. Others have also dedicated expertise and resources, such as St. Jude Children’s Research Hospital (a WHO Collaborating Centre for Childhood Cancer), which supported the inception of the Global Initiative and contributed resources to develop and implement priority activities. 
 

WHO and the International Agency for Research on Cancer (IARC) collaborate with the International Atomic Energy Agency (IAEA) and other UN organizations and partners, to: 

• increase political commitment for childhood cancer diagnosis and treatment;
• support governments to develop high-quality cancer centres and regional satellites to ensure early and accurate diagnosis and effective treatment for children with cancer;
• develop standards and tools to guide the planning and implementation of interventions for early diagnosis, treatment and palliative and survivorship care, all of which take account of the specificities of childhood cancer;
• improve access to affordable and essential medicines and technologies; and
• support governments to safeguard families of children with cancer from financial ruin and social isolation as a result of cancer care.