A report by the International Agency for Research on Cancer (IARC) based on data from more than 100 cancer registries in 68 countries shows that from 2001 to 2010, the occurrence of childhood cancer worldwide was 13% more common than in the 1980s.¹ In addition, the report’s findings showcase stark differences in global cancer occurrence patterns. For example, leukemia and lymphoma constitute nearly half of all childhood cancers worldwide, with leukemia the most common type of childhood cancer, except in sub-Saharan Africa, where Burkitt lymphoma is related to the Epstein-Barr virus and chronic malaria.

Given the limitations of quality cancer registration, the global burden of childhood cancer is not well known. However, existing estimates show that, every year, between 160,000 and 240,000 children and adolescents are diagnosed with cancer.²

Advancements in treatments for childhood and adolescent cancers have resulted in high survival rates in high-income countries such as the United States, where survival in childhood cancers has reached more than 80%. However, in low-income countries, survival rates are as low as between 10% and 20%.³

The increase in the global childhood cancer incidence, which may be even higher than reported due to a lack of access to diagnostic tools and basic medical care in many low-income countries, has led many scientists to conclude that childhood cancers pose an increasing public health risk to children, especially those in countries that lack access to high-quality medical care. To reduce the health-care inequities in children and adolescents in low- and middle-income countries and improve cancer survival rates, this past fall, St. Jude Children’s Research Hospital and the World Health Organization (WHO) announced a 5-year, $15 million partnership with the goal of curing at least 60% of children around the world diagnosed with the 6 most common cancers by 2030. The six cancers are acute lymphoblastic leukemia, Burkitt lymphoma, Hodgkin lymphoma, low-grade glioma, Wilms tumor, and retinoblastoma.

Through this collaboration, St. Jude Children’s Research Hospital and WHO will endeavor to bring together stakeholders in childhood cancer worldwide to increase access to care in low-resource countries, strengthen oncology training programs to develop national centers of excellence and regional satellites to improve quality of care, and influence the integration of childhood cancer into national policies to increase survival rates for all children with the disease.

Carlos ­Rodriguez-Galindo, MD

“We started working with WHO a few years ago, as we realized that there was a strong need to join forces in low- and middle-income countries to improve their health-care systems and develop national cancer control plans,” said Carlos ­Rodriguez-Galindo, MD, Executive Vice President, Chair of the Department of Global Pediatric Medicine, and Director of St. Jude Global at St. Jude Children’s Research Hospital in Memphis. “Our hope is that we will help WHO develop a global response to childhood cancer survival rates through this initiative by bringing together all the stakeholders who are needed to approach this challenge.”

St. Jude Children’s Research Hospital has been involved in global pediatric oncology since 1993, when it launched the International Outreach Program. This program has now been expanded through St. Jude’s latest initiative, St. Jude Global, which develops models to advance care for children with cancer around the world with comprehensive programs in capacity-building, education, and research.

The ASCO Post talked with Dr. Rodriguez-Galindo about St. Jude’s collaboration with WHO and how this partnership as well as its other global programs are improving survival rates for children with cancer.

Taking St. Jude to the World

Why did so few children (3%) benefit from the International Outreach Program when it was launched in 1993? How do you hope to cure at least 60% of the world’s children with cancer over the next decade?

Our International Outreach Program was more of philanthropic and humanitarian effort to build oncology care capacity wherever there was a need, but that was in the 1990s, when global oncology was not part of the mainstream of global health. At that time, we were able to improve cancer care access in just one hospital in one country. That’s what prompted us to ask, how can we maximize our impact and improve outcomes for children with cancer in the world?

Over the next 20 years, we gradually increased our international presence, establishing 24 partner sites in 17 countries: Brazil, Chile, China, Costa Rica, the Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Jordan, Lebanon, Mexico, Morocco, Nicaragua, the Philippines, and Venezuela. In 2016, we formed the Department of Global Pediatric Medicine to bring high-quality pediatric cancer care to all children and teens between the ages of 0 and 19 in low- and middle-income countries, where more than 80% of children with cancer live. The Department of Global Pediatric Medicine is the core of our effort to impact childhood cancer around the world by incorporating a global mission into St. Jude’s mission to advance cures and prevent pediatric cancers through research and treatment and a global vision to harness talent and resources across St. Jude and globally; develop strong regional networks; and within the next decade, influence the care of 60% of children with cancer worldwide.

The goals of this effort are to develop global, regional, national, and local patient-centered initiatives that improve access to quality care; study social, economic, genetic, and environmental factors that cause differences in incidence and outcomes of pediatric cancers worldwide; develop quality and performance metrics to guide capacity-building initiatives; create innovative approaches to strengthen health-care systems; create a global research infrastructure to support the generation of new information; develop best practices for sharing expertise and resources; advance a research culture that provides survival improvement within each country; and create a global education platform that addresses the human resource gaps in childhood cancer care.

This past May, we launched St. Jude Global, a new initiative that reflects those goals, to bring together everyone at St. Jude in pursuit of the vision that inspired the foundation of our hospital: no child should die in the dawn of life, anywhere.

Overcoming Obstacles

How can you bring high-quality cancer care to low- and middle-income countries with so few resources to adequately treat the disease?

We realize this is a long process and we won’t achieve our goals overnight. We know it may take several decades before we reach our goals, but we consider improving survival rates in children with cancer an urgent matter, and every day we work with that sense of urgency in mind. We try to be strategic in identifying the cancer burden in each country and the cancer burden distribution across the globe. Then we develop reasonable geographic, sociopolitical, and geopolitical strategies with the ministers of health in each country, and with WHO to identify areas in which we can work together, for example, in public policy or in education.

Once we have defined the strategy, we try to implement regional, national, and hospital-based initiatives that impact every aspect of the continuum of cancer care from strengthening each country’s health-care system, to improving services like palliative care, enhancing quality of care and drug availability, and building an oncology workforce through the St. Jude Global Academy.

We are currently applying this model within the following regions: Mexico, Central America, South America, sub-Saharan Africa, Eastern Mediterranean (including North Africa and the Middle East), Eurasia, China, and Southeast Asia. All of these regions have different teams dedicated to the specific needs of each country to improve access to care and deliver context-adapted state-of-the-art therapy for children with cancer.

How do you overcome the warring conflicts in some of these countries to ensure that children with cancer receive care?

Our global mission to deliver pediatric cancer care means we go where we are needed. Many low-income countries need us precisely because they are unstable and cannot prioritize health care for their citizens. We are supporting programs in several countries where political and humanitarian crises limit access to care, such as in the Middle East. For example, in 2013, we created a separate humanitarian fund to address the Syrian refugee crisis; since then, we have been providing support for the treatment of Syrian children with cancer in Lebanon and Jordan.

“Many low-income countries need us precisely because they are unstable and cannot prioritize health care for their citizens.”

— Carlos Rodriguez-Galindo, MD

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This humanitarian relief fund is matched with training programs in the region to rebuild capacity for pediatric oncology in Syria, Iraq, and Palestine. However, there are many other countries where armed conflicts, civil unrests, or natural disasters disrupt the provision of care. We understand that in those circumstances, childhood cancer is not a priority for governments with so many competing needs. But we are true to our mission, and every single child with cancer matters to us. We try to compensate for the lack of investment in cancer care by countries and support their childhood cancer programs in the best way we can.

Reducing Childhood Cancer Deaths

In March 2018, St. Jude was named the first WHO Collaborating Centre for Childhood Cancer to transform pediatric cancer care worldwide. How will you accomplish the goal of curing at least 60% of children with 6 of the most common types of cancer by 2030?

We started working with WHO a few years ago to reduce global disparities in childhood cancer care. We first experienced WHO’s strong convening power in Myanmar, where we worked together with the organization and other stakeholders to develop the first National Workshop on Childhood Cancer Control, which initiated a process for the development of the National Childhood Cancer Control Plan in that country. This led to additional collaborations with WHO and the Pan American Health Organization in the Americas, Eurasia, and the Asia-Pacific region.

The St. Jude–WHO partnership to reduce deaths in children with cancer is the result of the United Nations World Health Assembly Resolution 70.12 on cancer prevention and control adopted in 2017. This resolution requires a commitment from WHO and individual governments to increase services for childhood cancer as part of their national cancer control programs and allocate resources under the umbrella of universal health care.

Through our agreement, which was signed on July 20, 2018, St. Jude will provide the resources to WHO to articulate a global response to reduce cancer deaths in children, bringing together many partners around the world. We hope this partnership with WHO and many other stakeholders will help all low-resource countries develop cancer control plans to improve cure rates for children with cancer. We would like to reach a 60% cure rate for children with 6 of the most common cancers by 2030, with additional goals for the less-common cancers. With these goals in mind, we hope to save the lives of one million children.

This is the matrix we developed to align the childhood cancer agenda with the sustainable development goals outlined in the World Health Agency Resolution to improve survival rates by 2030.

Global Movement to Improve Care for Children With Cancer

Are you also hoping to partner with cancer foundations and societies in the United States, such as ASCO, to contribute to the efforts of the St. Jude Global Initiative?

We are just at the beginning stages of our initiatives, but, yes, we would love to engage as many organizations and foundations as possible, and this is our intention. There is a huge need for as many people and groups to be involved in this effort as possible.

We would definitely love to partner with ASCO. I am a member of ASCO’s Cancer Communications Committee, and I have talked with committee members and also with ASCO President Monica M. Bertagnolli, MD, FASCO, to inform them about this initiative. ASCO has such a strong voice on a global level, and we welcome ASCO members to be part of this effort to reduce pediatric cancer deaths globally.

This is not the work of one institution or of five institutions. To be successful, many institutions and societies have to be involved. We want to create a global movement to reduce the global gaps in access to care for children with cancer and dramatically reduce cancer deaths over the next decade.

We are happy to help other organizations set up programs. For more information about St. Jude Global and how to participate in these programs, or how to start your own, ASCO members can visit https://www.stjude.org/global.html.

If we all contribute to this effort, hopefully, over the next decade, we can effectively reach our goals to advance children’s access to quality cancer care and ensure that fewer young lives are needlessly cut short by cancer and other treatable diseases. ■

DISCLOSURE: Dr. Rodriquez-Galindo reported no conflicts of interest.

REFERENCES

1. Steliarova-Foucher E, Colombet M, Ries LAG, et al: International incidence of childhood cancer, 2001-10: A population-based registry study. Lancet Oncol 18:719-731, 2017.

2. Bhakta N, Force LM, Allemani C, et al: Childhood cancer burden: A review of global estimates. Lancet Oncol 20:e42-e53, 2019.

3. World Health Organization: Cancer in Children. Available at www.who.int/news-room/fact-sheets/detail/cancer-in-­children. Accessed April 29, 2019.