Introduction:

The meeting will focus on the Latin American region and bring together leading practitioners and representatives from ministries of health to discuss how childhood cancer can be integrated with national child health plans and stragies. Participants will also discuss ways to increase the visibility of childhood cancer in global public health discussions. 

The first day's agenda will be a Stakeholder Dialogue entitled 'Advancing the Development of National Childhood Cancer-care Strategies in Latin America'. The stakeholder dialogue has been organized by the McMaster Health Forum who have also developed an accompanying evidence brief to inform the dialogue and provide a framework for discussion. The second day's agenda has been organized by the Union for International Cancer Control (UICC) in collaboration with the Hospital for Sick Children in Toronto, Canada and will focus on ways to integrate early detection, treatment, care and survivorship, and monitoring and evaluation into national health services.  

Non-communicable diseases including childhood cancer are an increasingly important public health priority. Major shifts in the magnitude and causes of childhood mortality have occurred in many low- and middle- income countries (LMIC), including 106 countries with accelerated declines in childhood mortality from 1990-2011; 80% of this decline was due to reductions in death from infectious causes. A large, and growing, proportion of global childhood mortality is therefore due to non-communicable diseases. Indeed, 6.0% and 18.6% of deaths among children ages 5-14 years in lower- and upper-middle-income-countries (MIC) respectively are due to cancer. As is already the case in high-income countries (HIC), cancer represents the leading cause of non-accidental death among children in a growing number of MIC. In absolute terms, of the 175,000 children diagnosed with cancer annually, an estimated 150,000 live in LMIC. Even this figure represents a substantial underestimate given the endemic under-diagnosis and under-registration of LMIC children with cancer. Unlike many adult malignancies, most pediatric cancers are not associated with modifiable risk factors and are not amenable to population-based screening and prevention programs. Decreasing childhood cancer mortality thus requires accurate and timely diagnosis followed by effective treatment. Fortunately, such treatment exists; in HIC over 80% of children with malignancies are cured. The survival rate for children with cancer in many LMIC is however dramatically lower, ranging from 10% to 60% across settings. The vast majority of childhood cancer related deaths therefore take place in LMIC. Improving care for LMIC children with cancer will require addressing several challenges: low levels of awareness and knowledge of childhood cancer among health workers, weak or non-existent referral systems for diagnosis, treatment and care, insufficient human and infrastructural capacity, inconsistent availability of chemotherapeutic and pain relief drugs, lack of pediatric cancer registries and absence of national childhood cancer strategies. The huge gap in survival for children with cancer between high income and LMIC is unacceptable and a matter of the right to health and social justice for children. As stated in article 24 of the Convention on the Rights of the Child “State Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.” Much can be done at the national level to meet the needs of children with cancer. Though formal costing studies are lacking, preliminary evidence suggests that investment in childhood cancer is cost effective, as even modest investments in treatment can raise cure rates. For example, at least 50% of children with Burkitt’s lymphoma in Sub-Saharan Africa can be cured with a simplified chemotherapy regimen costing approximately USD $50 per case. The government of Mexico has recently expanded their nascent universal healthcare insurance program to include childhood cancer treatment. Actions can therefore be taken across resource levels to reduce inequities in access to medical care and improve the survival and quality of life for children with cancer. Current efforts are however both limited and sporadic; international coordination is lacking. Defining and implementing effective national action across multiple settings is therefore the focus of this proposal along with the identification of effective coordination mechanisms.