Almost 60% of all deaths from pediatric cancers occur in regions of armed conflict, according to the results of a study published in The Lancet Oncology.
Investigators from St. Jude Children’s Research Hospital, Duke University, and other institutions sought to reveal the relationship between childhood cancer mortality and armed conflict to ultimately work toward improving global pediatric cancer care.
“The impact of war on civilian health goes beyond immediate trauma; a major threat is the disruption of health-care systems,” stated co-senior author Asya Agulnik, MD, MPH, Director, St. Jude Global Critical Care Program, and Associate Member, Department of Global Pediatric Medicine. “In high-resource settings, coordinated multidisciplinary care achieves an 85% survival rate for childhood cancer through timely diagnosis and treatment. However, in conflict-affected areas, these processes are severely compromised, leading to diagnosis and treatment delays and increased mortality risk. Importantly, while the incidence of childhood cancer is consistent globally, survival rates differ significantly due to these disruptions.”
“Our study found that even low levels of conflict detrimentally affect children’s cancer outcomes in those countries. We have to pay attention to not only the high levels of conflict picked up in the news, but also the smaller, more chronic levels of instability and conflict countries face when it comes to caring for children with cancer,” stated corresponding and co-senior author Emily Smith, PhD, Departments of Surgery and Emergency Medicine, Duke University School of Medicine, and Duke Global Health Institute Center for Global Surgery and Health Equity.
In order to reach the goal of the Global Initiative for Childhood Cancer of increasing survival for children with cancer to at least 60% globally, issues of childhood cancer care in regions of conflict must be addressed. To do so will require the work of new multidisciplinary collaborations, the study authors concluded.
Study Methods and Results
The investigators collected global ecological data to calculate the number of children with cancer in countries in conflict and not in conflice and to compare with the pediatric cancer mortality rates between countries in conflict and not in conflict.
Data on armed conflicts worldwide from 1990 to 2019 were collected from the Uppsala Conflict Data Program. For the purpose of the study, a country in conflict was defined as one with at least 25 battle-related deaths per year; a country at war was defined as one with at least 1,000 battle-related deaths per year.
Data on children and adolescents aged 0 to 19 years with cancer were gathered from the Global Burden of Disease 2019 for between 1990 and 2019.
The study estimated that approximately one-half of children around the world lived in countries experiencing armed conflict within the past 3 decades, and almost 60% of childhood cancer deaths occurred in these regions.
In 2019 specifically, 46% of 394,000 new global pediatric cancer cases occurred in countries in conflict. Further, 57.7% of 131,000 global pediatric cancer deaths occurred in countries in conflict in 2019.
“The burden of pediatric cancer is disproportionately shifted not only to low-income countries but also countries in conflict. So, most childhood cancer cases and deaths occur in countries that are affected by conflict, and that proportion has been steadily increasing over time,” said Dr. Agulnik.
The median mortality rate between 1990 and 2019 was 20% to 30% higher in countries in conflict compared with countries not in conflict. Analysis showed that findings were similar for every year over the past 3 decades. Yet the rate of childhood cancers has remained stable over the same period. In countries with conflict, however, the incidence rates have increased over the decades, from 37.4% in the first decade to 44.3% in the third decade (P < .001). The rate of childhood cancer deaths also increased over time from 46.0% in the first decade to 55.1% in the third decade (P < .001).
When data were stratified by the intensity of the conflict, the greatest increase in cancer deaths over time was seen in countries with minor conflict (between 25 and 999 battle-related deaths per year). The rate was almost doubled by 2019 to 43.2% of all childhood cancer deaths occurring in countries in minor levels of conflict (P < .001).
“Children are a vulnerable population that often get caught up in conflicts, not of their own fault or doing. Our study shows that protecting them, particularly the most vulnerable with acute health conditions that require strong health systems, like cancer, is critical given the growing mortality rates in countries with conflict,” Dr. Smith stated.
The study provides findings that can be used to support global policymaking and advocate for sustainable health-care services in conflict-affected areas.
“This research is a great example of how multiple institutions can collaborate to tackle a complex issue,” Dr. Agulnik concluded. “It symbolizes the kind of multifaceted interventions needed to address this challenge. Solving it cannot be the work of a single entity; it requires diverse expertise from various sources, particularly from those on the ground.”
Disclosure: For full disclosures of the study authors, visit thelancet.com.
