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GLOBAL CANCER INITIATIVES

17 CANCER CONTROL 2021

Background

Childhood cancer is a growing burden in high-income

countries (HIC) as well as low- and middle-income countries

(LMIC) (1). Survival rates are up to 85% for most diseases in

HIC, however this cure rate is not achieved across the rest of

the world where >80% of children live (2). In general, children

with cancer in HIC are diagnosed in an early stage of their

disease, which improves their chance for cure. This is not

the experience of most children in LMICs, where all levels of

medical professionals may be unfamiliar with the symptoms

of childhood cancer, referral processes are weak and tertiarylevel

care is limited to the capital or perhaps one other large

city (3). Africa has a population of close to 1.34 billion (4), but as

of 2021, only includes one HIC (Seychelles) and seven UMICs

(5). As the rate of infectious disease decreases across Africa

and other resource-limited settings, the noncommunicable

disease burden (e.g., cancer) increases and is receiving global

attention as reflected by government representatives at the

WHO seventy-fourth World Health Assembly (6). Economic

development in the recent past across Africa has been

improving steadily despite contraction due to the 2020 global

pandemic (7). Nevertheless, regional economic recovery

(albeit variable) is expected as vaccines become available, and

children/adolescents continue to receive treatment for cancer

across this continent.

In 2018, SIOP initiated a Global Mapping Programme for

childhood cancer to determine available services and support

for childhood cancer treatment especially in continents with

many LMICs. The first continent surveyed was Africa since

little documentation of the level of available treatment and

family support services was available. The Global Mapping

Programme provides an up-to-date picture of resources,

staffing, and facility-level capacity to i) advocate for more

resources; ii) enable collaboration to share data, and if

appropriate, join clinical trials; and iii) produce an online map of

childhood cancer treatment facilities. The survey methodology

is described in detail by Geel et al., 2021 (8).

Key elements of successful childhood cancer

programmes

This article reflects on childhood cancer across Africa as

documented in the first phase of the SIOP Global Mapping

Programme. Here, we address access to and importance of

key elements of childhood cancer care. The first author, parent

of a survivor of childhood cancer, identified specific survey

data to highlight disparities and commonalities in treatment

in the United Kingdom compared to countries in Africa from

a parent perspective. We hope the findings and commentary

presented here provide a baseline portrait of achievements

to date, as well as a roadmap for moving forward locally and in collaboration with global efforts, e.g., the WHO Global

Initiative for Childhood Cancer (GICC). The GICC aims to

improve childhood survival to 60% by 2030 worldwide (1).

Selected key elements of childhood cancer care presented here

are essential to achieving this goal and making a difference

in the lives of children/adolescents with cancer in LMICs.

Current disparities and gaps in childhood cancer care must be

documented to be successfully eliminated - this is the purpose

of the SIOP Global Mapping Programme.

What happens if there is no or limited childhood

cancer treatment in your country?

Neil Ranasinghe, parent of a survivor of childhood leukaemia,

and member of the SIOP Global Health Network, and SIOP Global

Mapping Programme Core Team member

African data from the SIOP Global Mapping Programme

showed a wide disparity in services and facilities available

to children/adolescents with cancer and their families.

Some hospitals are well equipped and offer chemotherapy,

radiotherapy and specialised surgery, whilst others only

provide basic cancer care. Some countries have no paediatric

oncologists meaning that adequate cancer therapy is extremely

difficult to provide.

There are countries with literally no facilities treating

children/adolescents with cancer (9). In some cases, e.g.,

Eswatini, the children are sent to neighbouring South Africa for

treatment, however, this is disruptive to the families' lives and

leaves siblings and other family members at home who would

normally serve as a support system for the child and parent.

Many childhood cancer care actions and treatments

can be implemented at a national level in Africa and are

not prohibitively expensive (10). Outcomes for children/

adolescents with cancer across Africa will not improve

without a well-trained paediatric oncology health workforce.

Other factors that significantly improve outcomes includes

appropriate medical imaging, universal health coverage,

locally relevant research, cancer registries and support from

non-governmental organizations (NGOs). The SIOP Global

Mapping Programme provides updated documentation of

capacity in the region. The following addresses each of these

elements of childhood cancer care, written by an African or

international expert on the selected topic.

Access and importance of medical imaging for

childhood cancer across Africa

Dr Joyce Balagadde Kambugu, Head of Paediatric Oncology,

Uganda Cancer Institute

Limited access to imaging is one of several contributors to

poor outcomes of childhood cancer in Africa. While this can

be attributed to inadequate resource allocation to healthcare

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