The CureAll Framework: WHO’s Initiative to Combat Childhood Cancer

The CureAll framework, launched by the World Health Organization (WHO), aims to significantly improve childhood cancer survival rates globally by 2030. Its primary objective is to achieve at least 60% survival while reducing suffering for all children diagnosed with cancer.

This initiative stems from WHO’s alarming findings: out of an estimated 400,000 children who develop cancer each year, survival rates differ drastically based on economic factors. While 80% of children survive in high-income countries, survival in low and middle-income countries (LMICs) is as low as 30%.

Addressing this disparity is critical, and nations like India must strengthen their childhood cancer care to contribute meaningfully to the global goal.

Childhood Cancer Care in India: A Grim Reality

A policy brief titled "A Situational Analysis of Childhood Cancer Care Services in India, 2022" released by the Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR) has brought to light the severe gaps in childhood cancer management in India. According to this report:

• 4% of all cancers in India occur in children (ages 0-14 years), many of which lead to physically and cognitively debilitating conditions.

• Less than half of public and private tertiary hospitals have a dedicated pediatric oncology department.

• Specialized medical personnel are scarce, particularly in public hospitals:

  • Pediatric oncologists (48%)

  • Pediatric onco-surgeons (14.2%)

  • Pediatric intensivists (38.9%)

  • Medical oncologists (46.7%)

  • Palliative care physicians (37.6%)

• Less than 50% of public and private hospitals have trained pediatric cancer nurses and palliative care staff.

• Cancer treatment drugs remain inadequate, as less than 50% of public hospitals have the necessary four classes of childhood cancer medications.

These stark realities highlight the absence of a dedicated national policy for childhood cancers, as India’s current cancer programs predominantly focus on adult cancers.

Need for a Comprehensive Childhood Cancer Policy

To bridge the existing gaps, the ICMR-NCDIR policy brief strongly recommends formulating a National Childhood Cancer Policy. A dedicated approach would ensure:

• Timely diagnosis, treatment, and follow-up care through well-structured pathways.

• State governments prioritize childhood cancer care by integrating it into the national cancer control response.

• Stronger financing mechanisms and health insurance coverage for childhood cancer treatments.

• Training programs for general physicians and primary care providers to help identify symptoms early and enable timely referrals.

• Expansion of pediatric oncology units and workforce training in both public and private hospitals.

• Large-scale awareness campaigns to educate parents about early warning signs, ensuring timely medical intervention and treatment adherence.

The Special Case of Northeast India

Findings from the National Cancer Registry Programme indicate that the cumulative risk of developing cancer is highest in Assam and the northeastern states. While most adult cancers in the region are lifestyle-related (e.g., smoking, alcohol consumption, obesity, poor diet, lack of exercise, etc.), studies suggest that childhood cancer has little to do with lifestyle choices. However, the overwhelming focus on adult cancer management often sidelines childhood cancer cases.

A comprehensive childhood cancer survey in the northeastern region would help:

• Identify critical gaps and assess the urban-rural distribution of childhood cancer cases.

• Raise awareness among parents to recognize symptoms early and seek timely medical help.

• Aid policymakers in designing targeted interventions to improve access to childhood cancer care.

Financial Burden and the Role of State Governments

The ICMR-NCDIR report on "Monitoring Survey of Cancer Risk Factors and Health System Response in North Eastern Region of India, 2022" revealed that:

• Nearly one-third of cancer patients seek treatment outside their home state.

• 26% of patients fund their cancer treatment out of pocket.

• Only 5.85% of patients have health insurance coverage for cancer treatment.

To address these financial barriers, state governments must allocate sufficient funds in their budgets for childhood cancer care while ensuring efficient utilization of resources.

Role of Communities, NGOs, and Public-Private Partnerships

Community support and NGO involvement can play a crucial role in reducing the burden on public hospitals by:

• Spreading awareness about childhood cancer and its early warning signs.

• Establishing charitable hospitals to provide affordable or free treatment.

• Facilitating access to financial aid for families struggling with cancer treatment costs.

A public-private partnership could help address infrastructure gaps, medical training needs, and human resource shortages, ultimately reducing the waiting time for childhood cancer patients.

The Road Ahead: WHO’s Vision for Childhood Cancer Care

According to WHO, childhood cancers can be treated successfully using generic medicines, surgery, and radiotherapy, making treatment cost-effective even in low-income settings. To achieve WHO’s CureAll framework goal of 60% survival by 2030, India must:

• Develop a national childhood cancer policy that prioritizes timely diagnosis and treatment.

• Improve healthcare infrastructure by expanding pediatric oncology units and increasing trained manpower.

• Enhance affordability and accessibility of childhood cancer treatments.

• Increase public awareness about childhood cancer to ensure early diagnosis and adherence to treatment.

By implementing these measures, India can significantly improve childhood cancer survival rates and contribute to WHO’s global mission of reducing childhood cancer mortality and suffering worldwide.

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