Global Childhood Cancer Survival Estimates and Priority-Setting: A Simulation-Based Analysis

This modelling study provides estimates of global childhood cancer survival, accounting for the impact of multiple factors that affect cancer outcomes in children. The authors developed a microsimulation model to simulate childhood cancer survival for 200 countries/territories, accounting for clinical and epidemiologic factors, including country-specific treatment variables, such as availability of chemotherapy, radiation, and surgery, and calibrated the model to empirical data from the CONCORD-2 and CONCORD-3 studies using an Approximate Bayesian Computation approach. The model estimated that, for diagnosed cases, global 5-year net childhood cancer survival was 37.4% (95% UI 34.7-39.8), with large variation by region, ranging from 8.1% (4.4-13.7) in eastern Africa to 83.0% (81.6-84.4) in North America. Among the seven policy interventions modelled, each individually provided small gains, but 5-year net survival increased more substantially when policy interventions were bundled into packages that improved service delivery (50.2% [47.3-53.0]) or that expanded treatment access (54.1% [50.1-58.5]). A comprehensive systems approach consisting of all policy interventions yielded superadditive gains with a global 5-year net survival of 53.6% (51.5-55.6) at 50% scale-up and 80.8% (79.5-82.1) at full implementation. Overall, childhood cancer survival varies widely by region, with especially poor survival in Africa. Although expanding access to treatment and addressing financial toxicity are essential, investments that improve the quality of care, at both the health-system and facility level, are needed to improve childhood cancer outcomes globally.