Childhood cancer inequalities in the WHO European Region

World Health Organization | February 2022 | Childhood cancer inequalities in the WHO European Region

Key points from the report Childhood cancer inequalities in the WHO European Region

Image source: apps.who.int Image description: front cover of the report showing illustrations of children playing and reading

Childhood cancer encompasses a wide and heterogeneous range of rare cancers defined by the age group in which they occur. While significant progress has been made in recent years in improving survival and treatment quality for children with cancer, significant inequalities still exist across the
WHO European Region. This report draws together available evidence and information from a wide range of published sources to present the case for an increased focus on addressing inequalities in childhood cancer within the Region. It summarizes literature in four main areas: the childhood
cancer continuum; inequalities across countries; inequalities within countries; and childhood cancer as a driver of inequalities. The report makes recommendations on the key steps that are likely to have the greatest impact in reducing inequalities across the Region. It is hoped that these will be of value to decision-makers and politicians from all countries within the Region looking to address existing inequalities in childhood cancer care through targeted improvement activities.

This WHO report summarises literature in four main areas: the childhood cancer continuum; inequalities across countries; inequalities within countries; and childhood cancer as a driver of inequalities (Source: World Health Organization).

Childhood cancer inequalities in the WHO European Region [report]

See also:

Childhood cancer inequalities in the WHO European Region (2022)

Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study #Covid19RftLks

Mukkada, S. et al | 2021 | Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study | The Lancet Oncology | DOI:https://doi.org/10.1016/S1470-2045(21)00454-X

In this multinational cohort (World Bank income groups) of children and adolescents with cancer and COVID-19, severe and critical illness occurred in one fifth (19·9 per cent) of patients and deaths occurred in a higher proportion (3·8%; 50 of 1 319) than is reported in the literature in the general paediatric population. The authors’ analysis of hospital-based registry of paediatric oncology patients with confirmed SARS-CoV-2 infections, enabled them to study the effect of the disease across heterogeneous supportive care protocols and demographic background Additionally, they found that variables associated with treatment modification were not the same as those associated with greater disease severity. They also identify to identify several clinical patient factors, including lymphopenia and neutropenia, which were associated with more severe disease. Their data could inform clinical practice guidelines and raise awareness globally that children and adolescents with cancer are at high-risk of developing severe COVID-19 illness (Source: Mukkada et al, 2021).

Background

Previous studies have shown that children and adolescents with COVID-19 generally have mild disease. Children and adolescents with cancer, however, can have severe disease when infected with respiratory viruses. In this study, we aimed to understand the clinical course and outcomes of SARS-CoV-2 infection in children and adolescents with cancer.

Methods

We did a cohort study with data from 131 institutions in 45 countries. We created the Global Registry of COVID-19 in Childhood Cancer to capture de-identified data pertaining to laboratory-confirmed SARS-CoV-2 infections in children and adolescents (<19 years) with cancer or having received a haematopoietic stem-cell transplantation. There were no centre-specific exclusion criteria. The registry was disseminated through professional networks through email and conferences and health-care providers were invited to submit all qualifying cases. Data for demographics, oncological diagnosis, clinical course, and cancer therapy details were collected. Primary outcomes were disease severity and modification to cancer-directed therapy. The registry remains open to data collection.

Findings

Of 1520 submitted episodes, 1500 patients were included in the study between April 15, 2020, and Feb 1, 2021. 1319 patients had complete 30-day follow-up. 259 (19·9 per cent) of 1301 patients had a severe or critical infection, and 50 (3·8 per cent) of 1 319 died with the cause attributed to COVID-19 infection. Modifications to cancer-directed therapy occurred in 609 (55·8 per cent) of 1092 patients receiving active oncological treatment. Multivariable analysis revealed several factors associated with severe or critical illness, including World Bank low-income or lower-middle-income (odds ratio [OR] 5·8 [95 per cent CI 3·8–8·8]; p less than 0·0001) and upper-middle-income (1·6 [1·2–2·2]; p equal to 0·0024) country status; age 15–18 years (1·6 [1·1–2·2]; p=0·013); absolute lymphocyte count of 300 or less cells per mm³ (2·5 [1·8–3·4]; p less than 0·0001), absolute neutrophil count of 500 or less cells per mm³ (1·8 [1·3–2·4]; p=0·0001), and intensive treatment (1·8 [1·3–2·3]; p equal to 0·0005). Factors associated with treatment modification included upper-middle-income country status (OR 0·5 [95 per cent CI 0·3–0·7]; p equal to 0·0004), primary diagnosis of other haematological malignancies (0·5 [0·3–0·8]; pequal to 0·0088), the presence of one of more COVID-19 symptoms at the time of presentation (1·8 [1·3–2·4]; p equal to 0·0002), and the presence of one or more comorbidities (1·6 [1·1–2·3]; p equal to 0·020).

Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study [primary paper]

Mindfulness-Based Interventions for Symptom Management in Children and Adolescents With Cancer: A Systematic Review

Tomlinson, D., Sung, L., Vettese, E., Murphy, S., & Plenert, E. (2020). Mindfulness-Based Interventions for Symptom Management in Children and Adolescents With Cancer: A Systematic Review| Journal of Pediatric Oncology Nursing| 1043454220944126.

Abstract

Psychological interventions have shown benefit in reducing symptoms in children and adolescents with cancer. More recently, mindfulness-based interventions (MBIs) have been shown to be a promising approach to symptom intervention in adolescents with chronic illnesses. In this systematic review, we aimed to describe MBIs or focused-breathing interventions that have been used to treat symptoms in children receiving cancer therapy. A systematic review was conducted using MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO from inception to September 2019. We identified relevant articles in which MBIs or focused-breathing interventions were the primary interventions delivered to improve symptoms in children or adolescents with cancer. Six studies met the inclusion criteria. MBIs included controlled breathing and belly breathing. Intervention effects were found to be beneficial with regard to symptoms that included procedural pain, distress, and quality of life. The interventions were generally well accepted and beneficial. All studies suffered limitations because of methodological flaws, including the lack of randomization, and small sample sizes. Despite the small numbers of studies and participants, MBIs delivered to children with cancer may have beneficial effects on certain symptoms. Implications for future research include interventions tailored to the specific symptom burden. Studies must aim to increase sample sizes as well as to include individuals at high risk for severe symptoms.

The Library & Knowledge Service can provide access to this article for Rotherham NHS Staff, request a copy here 

Cancer x Coronavirus: The impact on young people #covid19rftlks

Teenage Cancer Trust | June 2020 | Cancer x Coronavirus: The impact on young people

Coronavirus has disrupted the lives of all young people across the UK.
Schools and universities have shut, interrupting education at a critical time. Family, friends and partners have been cut off, breaking social connections. Those taking their first steps into work have found the jobs market stalled. Facing cancer on top of that feels unimaginably tough. Many young people with cancer are also deemed to be in the group most vulnerable to coronavirus, whilst the current evidence suggests that the majority of people their age are generally at less risk – further setting young people with cancer apart from their peers. Many have had to ‘shield’ – isolating themselves completely from others, for up to three months. They’ve told us how difficult this has been.

Even as schools start to return, rules about meeting others relax, and the rest of us slowly start to return to something approaching normality, young people with cancer face an
uncertain future.
Living with cancer already puts young people’s lives on hold while their peers move on. Living during a global pandemic adds a further layer of uncertainty and isolation.
We’re deeply concerned about the toll this period has taken on young people already going through one of the hardest times of their life.

The Teenage Cancer Trust has adapted its own Teenage Cancer Trust services,
staffed by specialist nurses and support teams, to the best of our ability to meet young people’s changing needs during the pandemic, including providing much more of our
peer support online.
But we wanted to find out how far young people with cancer feel their care has been disrupted by coronavirus.
I’d like to thank every young person who has shared their experiences for this project.
This report includes some clear recommendations for government and healthcare providers to take on board.
We’re also reviewing our own services to see where we can do more to meet some of the clear needs this research has identified. Creativity, determination and going the extra
mile have helped us to keep supporting young people – but we won’t stop there. As the situation evolves, so will our support so we can keep being there for young people
through this crisis and beyond.
Cancer is tough enough on its own. If we don’t get the next steps right, the long-term impact on young people with cancer will be significant.

Cancer x Coronavirus: The impact on young people

BMJ: Children with cancer are missing out on precision medicine, study finds

 Fulchand, S. | 2019|Children with cancer are missing out on precision medicine, study finds | BMJ  | 366 |l5696|  doi: https://doi.org/10.1136/bmj.l5696 (Published 24 September 2019) 

Researchers from the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust in London set out to evaluate whether their methods of DNA analysis could inform clinical treatment in young people with solid tumours. The study has now been published in The European Journal of Cancer 

Read the full BMJ article Children with cancer are missing out on precision medicine, study finds  

For a copy of the article contact the Library & Knowledge Service

Abstract  

Background

For children with cancer, the clinical integration of precision medicine to enable predictive biomarker–based therapeutic stratification is urgently needed.

 

Methods

We have developed a hybrid-capture next-generation sequencing (NGS) panel, specifically designed to detect genetic alterations in paediatric solid tumours, which gives reliable results from as little as 50 ng of DNA extracted from formalin-fixed paraffin-embedded (FFPE) tissue. In this study, we offered an NGS panel, with clinical reporting via a molecular tumour board for children with solid tumours. Furthermore, for a cohort of 12 patients, we used a circulating tumour DNA (ctDNA)–specific panel to sequence ctDNA from matched plasma samples and compared plasma and tumour findings.

 

Results

A total of 255 samples were submitted from 223 patients for the NGS panel. Using FFPE tissue, 82% of all submitted samples passed quality control for clinical reporting. At least one genetic alteration was detected in 70% of sequenced samples. The overall detection rate of clinically actionable alterations, defined by modified OncoKB criteria, for all sequenced samples was 51%. A total of 8 patients were sequenced at different stages of treatment. In 6 of these, there were differences in the genetic alterations detected between time points. Sequencing of matched ctDNA in a cohort of extracranial paediatric solid tumours also identified a high detection rate of somatic alterations in plasma.

 

Conclusion

We demonstrate that tailored clinical molecular profiling of both tumour DNA and plasma-derived ctDNA is feasible for children with solid tumours. Furthermore, we show that a targeted NGS panel–based approach can identify actionable genetic alterations in a high proportion of patients.

The article is available in full from the BMJ 

Research can be read at European Journal of Cancer 

[NHS England Consultation] Children’s Cancer Services

NHS England | June 2019 |Children’s Cancer Services

NHS England has launched a 60-day consultation to seek views on proposed changes to children’s cancer services. These are used by children aged between 0 and 16. In some cases, and with the agreement of Teenage and Young Adult’s Cancer Services, they may also treat teenagers up to the age of 18.

The aim of the service specifications is to improve the outcomes and experience of children and young people with cancer.

This consultation guide sets out:

• How care is currently provided.
• The proposed changes and reasons for these.
• How the proposed changes will be implemented.
• The consultation has been open from Wednesday 5 June and will run until Sunday 4 August 2019

See also:

NHS England blog 

India’s childhood leukaemia survival rate leaps to 80%, thanks to Manchester scheme

University of Manchester |June 2019 | India’s childhood leukaemia survival rate leaps to 80%, thanks to Manchester scheme

A paediatrician from the University of Manchester, Professor Vaskar Saha has helped cure children diagnosed with acute lymphoblastic leukaemia (ALL) by 15% during the five years he has led the ICICLE (Indian Childhood Collaborative Leukaemia Group) clinical project, in partnership with Tata Medical Centre, Kolkata.

Survival rates of most cancers in India are usually 15-25% lower than the United Kingdom. However, with Professor Saha’s work challenging the stereotype that cancer cure is a prerogative of affluent nations, his research has increased survival rates in Kolkata from 65% in 2014 to 80% in 2019.

Vaskar Saha, Professor of Paediatric Oncology at The University of Manchester and Senior Paediatric Consultant and Director of Translational Cancer Research at the Tata Medical Centre, Kolkata, said: “In the UK, 450 children are diagnosed annually with ALL, of which 400 will survive. In India, 9,000 of the 15,000 children diagnosed annually will survive.

“Not so long ago, four in ten Indian children would die because of poor treatment and relapse. The former was mainly due to the absence of standardisation in testing and treatment.

“If we can improve outcomes in India by 10%, then an additional 1,500 children a year grow up to lead normal lives.”

Professor Saha divides his time between Manchester and Tata Medical Centre

Before the ICICLE project launched, excellent medical centres across India were common and most children with acute lymphoblastic leukaemia were able to get the drugs they needed.

Historically, hospitals in India often work in isolation without exposure to the international research community. Travel costs to faraway hospitals were also difficult for poor families or those on low incomes.

Once clinicians started sharing their knowledge and standardised systems were put in place, change began to take root. (Source: University of Manchester)

Read the full story from the University of Manchester India’s childhood leukaemia survival rate leaps to 80%, thanks to Manchester scheme

 

New report shows more young people surviving cancer

Teenage Cancer Trust | January 2019 | New report shows more young people surviving cancer

A new report from Teenager Cancer Trust uses data collected by NCRAS  (National Cancer Registration and Analysis Service) which has been analysed to identify trends and share finding with partners to improve cancer services and awareness.  Now Teenage Cancer Trust report 13-24 years old who were diagnosed in England up to the end of 2015. The publication marks the first time a detailed analysis has been conducted of cancer rates of the 13 to 24-year age group and shows an encouraging increase in survival rates.

 

Some of the report’s key findings:

• Mortality rates of all cancers combined in 13 to 24 year olds have decreased from 42.9 per million in 2001 to 32.3 per million in 2015.
• The largest reduction in mortality by diagnostic group in England between 2001 and 2015 has been in Leukaemias. There were also reductions seen in mortality from Central Nervous System tumours, bone cancer and in lymphoma.
• Five-year survival rates for cancer in 13 to 24 year olds have risen from 83% females / 80% males in (2001-05) to 87% in females / 84 % males (2007-11).
• There are statistically significant variations in incidence and survival rates of cancer in 13 to 24 year olds based on geography and deprivation.
• The incidence of cancer in 13 to 24 years olds in England has increased from a crude rate of 233.1 per million in 2001, to 299.7 per million in 2015 (Source: Teenage Cancer Trust).

News release Teenage Cancer Trust New report shows more young people surviving cancer

The report is available to read and download from Teenage Cancer Trust 

BMJ Cancer: more young people in England are surviving

In the news: BBC News Teenage cancer survival ‘on the up’ in England, report finds

Childhood cancer burden: a review of global estimates

Bhakta, N.|(2019| Childhood cancer burden: a review of global estimates| The Lancet Oncology| 20|1| e42|e53.

A new article in the Lancet Oncology analyses 4 studies of the global cancer burden that included data for children and adolescents, with the aim that these data could help stakeholders to develop plans for national and institutional cancer programmes.

The Review provides guidance on improving future estimates of the childhood global cancer burden, as the data in low-income and middle-income countries is scarce. As such the researchers propose several recommendations to strengthen data collection and standardise analyses.

Summary

5-year net survival of children and adolescents diagnosed with cancer is approximately 80% in many high-income countries. This estimate is encouraging as it shows the substantial progress that has been made in the diagnosis and treatment of childhood cancer. Unfortunately, scarce data are available for low-income and middle-income countries (LMICs), where nearly 90% of children with cancer reside, suggesting that global survival estimates are substantially worse in these regions. As LMICs are undergoing a rapid epidemiological transition, with a shifting burden from infectious diseases to non-communicable diseases, cancer care for all ages has become a global focus. To improve outcomes for children and adolescents diagnosed with cancer worldwide, an accurate appraisal of the global burden of childhood cancer is a necessary first step. In this Review, we analyse four studies of the global cancer burden that included data for children and adolescents. Each study used various overlapping and non-overlapping statistical approaches and outcome metrics. Moreover, to provide guidance on improving future estimates of the childhood global cancer burden, we propose several recommendations to strengthen data collection and standardise analyses. Ultimately, these data could help stakeholders to develop plans for national and institutional cancer programmes, with the overall aim of helping to reduce the global burden of cancer in children and adolescents.

Rotherham NHS staff may request this article from the Library 

Genome sequencing of children promises a new era in oncology

Wise J.| 2019|Genome sequencing of children promises a new era in oncology BMJ | 364 |l105| doi: https://doi.org/10.1136/bmj.l105

All children with cancer in England will be offered whole genome sequencing from this year in a move that will enable more comprehensive and precise diagnosis and access to more personalised treatments.

According to NHS England’s long term plan, this will reduce the use of harmful drugs and interventions, support increased access to clinical trials, and reduce the number of young patients who have health problems caused by chemotherapy and radiotherapy

Darren Hargrave, honorary consultant paediatric oncologist at Great Ormond Street Hospital for Children and a member of the paediatric cancer task group which advised NHS England  says there are three major benefits:

• precision medicine
• refinement of diagnosis
• and screening for family members

It was also announced that children who need proton beam therapy will be able to access it in England rather than having to travel abroad. New proton beam facilities have been commissioned in London and Manchester, and will come online in the next couple of years (Source: BMJ)

Read the full, unabridged article at BMJ