Treatment-Related Mortality Among Children With Cancer in Low- and Middle-Income Countries

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In a systematic review and meta-analysis reported in The Lancet Oncology, Ehrlich et al estimated rates of treatment-related mortality among children with cancer in low- and middle-income countries. According to the study authors, approximately 90% of children with cancer globally live in these settings.

Study Details

The study involved the identification of articles published between January 2010 and 2021 reporting treatment-related mortality in pediatric patients aged 0 to 21 years with cancer in low- and middle-income countries. Only full-text articles were used; case reports (< 10 patients) and hematopoietic stem cell transplantation recipients were not included in the analysis.

Key Findings

A total of 501 studies representing 68,351 pediatric patients with cancer were included in the analysis. Among all patients, treatment-related mortality was estimated at 6.82% (95% confidence interval [CI] = 5.99%–7.64%), accounting for 4,437 (30.9%) of 14,358 total deaths.

Estimates of treatment-related mortality were 14.19% (95% CI = 9.65%–18.73%) in low-income countries, 9.21% (95% CI = 7.93%–10.49%) in lower–middle-income countries, and 4.47% (95% CI = 3.42%–5.53%) in upper–middle-income countries (overall P < .0001).

Among all patients, the overall estimate for treatment-related mortality did not change between 1989 and 2021 (slope = –0.001, P = .14). Treatment-related mortality remained unchanged in low-income countries (slope = 0.010, P = .21) and lower–middle-income countries (slope = –0.003, P = .16), but decreased in upper–middle-income countries (slope = –0.002, P = .0028).

The investigators concluded, “Approximately 1 in 15 children receiving cancer treatment in low- and middle-income countries die from treatment-related complications. Although treatment-related mortality has decreased in upper–middle-income countries over time, it remains unchanged in low- and middle-income countries. There is an urgent need for targeted supportive care interventions to reduce global disparities in childhood cancer survival.”

Asya Agulnik, MD, of the Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, is the corresponding author for The Lancet Oncology article.

Disclosure: The study was funded by American Lebanese Syrian Associated Charities and National Cancer Institute. For full disclosures of the study authors, visit

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