Every day, more than 1,000 children (aged 0–19 years) are diagnosed globally with cancer. Cancer is the second leading cause of death worldwide, according to the Institute for Health Metrics and Evaluation. For children living in high-income countries with access to excellent health care, the likelihood of surviving exceeds 80%. Unfortunately, the survival rate is only 15–45% for most children battling cancer who live in low-and middle-income countries. To help address this, in 2018 the Global Initiative for Childhood Cancer was created during the World Health Assembly at the World Health Organization (WHO), dictating the creation of a way to repair this disparity and injustice.
The CureAll framework seeks to improve global childhood cancer outcomes
Leading this effort is Sandra Luna-Fineman, MD, a pediatric oncologist at Children's Hospital Colorado (Children's Colorado), who partnered with the WHO and St. Jude Children's Research Hospital to create the CureAll framework, a shared operational approach to improve the health and well-being of children fighting cancer around the world, by the implementation of pediatric cancer services with appropriate infrastructure and access to life-saving medical strategies. The goal of the initiative is to achieve at least a 60% survival rate for children with cancer globally while ensuring that suffering is reduced for every child by 2030. CureAll is the acronym for the framework: Centers of excellence, Universal insurance coverage, Regimens of treatment and supportive care, and Evaluation and monitoring of outcomes; supported by Advocacy, Leveraged financing and Linked governance.
Supporting and strengthening low-income countries’ approaches to childhood cancer treatment
"The CureAll framework and technical package are designed to support and strengthen low-income countries' approach to treating childhood cancer," said Dr. Luna-Fineman, who is also an associate professor of pediatrics at the University of Colorado School of Medicine on the Anschutz Medical Campus. "I'm honored to be a part of this amazing group of people who care deeply about sharing our knowledge and advancements in childhood cancer care with institutions around the world, so they too have access to the latest and greatest cancer fighting tools."
"The CureAll framework and partnership with the best-known health institutions in the world offers hope to children everywhere fighting cancer – no matter what their socioeconomic situation may be," said Lia Gore, MD, section head of Pediatric Hematology/Oncology/Bone Marrow Transplant-Cellular Therapeutics at Children's Colorado and professor of pediatrics, Medical Oncology, and Hematology at the University of Colorado School of Medicine. "The fact that Children's Colorado's Dr. Luna-Fineman has played a lead and integral role in helping to create this program makes us immensely proud and grateful. We are surrounded by people at Children's Colorado like Dr. Luna-Fineman who work tirelessly to cure childhood cancer across the globe."
The CureAll framework includes a guide for policymakers
Dr. Luna-Fineman and the WHO first aimed to design a framework for an organized approach for the step-by-step enactment of the major needs of this unique pediatric population. A team of epidemiologists, pediatric oncologists and public health specialists with expertise in health networks, statistics and indicator design, have joined to build a guide for policymakers within the WHO regions and countries. The CureAll framework is supported with tools to:
- Assess the present state of the country's capabilities to diagnose, treat and support children with cancer and their families.
- Price the infrastructure and interventions needed for appropriate care; considering that not all countries will be able to start with a full slate of care services, but guide the way of how to improve outcomes as the financial capacity of the country allows.
- Foster close coordination with other United Nations agencies to help monitor the improvements and outcomes and the unique expertise in radiation diagnostics and therapies.
Success will be measured in many ways
The framework builds capacity with the aim of measuring progress through: public health indicators (such as mortality, incidence, nurse to patient ratio, percentage of beds occupied), direct care (early diagnosis through education of primary care medical and paramedical personnel, education of oncology personnel and quality improvement), quantifying specific clinical outcomes (survival, toxic death, nutritional monitoring, relapses by disease), and psychosocial determinants (abandonment of therapy, toxicity to family social and financial wellbeing).
The framework addresses six childhood and adolescent cancers
Six index childhood and adolescent cancers were chosen. Each is curable, brings aspects of biology and multidisciplinary care, and has well-developed therapeutics readily available. The six cancers are: Acute Lymphoblastic Leukemia, Burkitt Lymphoma, Hodgkin Lymphoma, Retinoblastoma, Wilms Tumor and Low-Grade Glioma.
There are multiple layers to the CureAll framework focusing on the broader needs of children with cancer including their growth, learning, development, nutrition, psychosocial well-being, reproductive health and long-term outcomes. The framework uses an integrated child-centered care approach with particular attention to the socioeconomic impact of a childhood cancer diagnosis on families.
The majority of deaths from childhood cancer can be avoided through a public health approach
According to the WHO, the likelihood of a child with cancer surviving is directly dependent on where the child lives, the socioeconomic status of the child's family and their underlying health system. The majority of deaths from childhood cancer can be avoided through a public health approach to cancer control focused on access to high-quality pediatric cancer treatments. Twenty-three governments have committed to strengthening childhood cancer programs, using the CureAll framework. More than 110 partner organizations are involved in the initiative, resulting in the rapid expansion of impact to more than 50 countries. This has translated into substantial improvements in the lives of children with cancer around the world.