Co-senior author Asya Agulnik, MD, MPH, St. Jude Department of Global Pediatric Medicine
More than half of all pediatric cancer deaths worldwide occur in regions of armed conflict, according to a new study led by investigators from St. Jude Children’s Research Hospital, Duke University and other collaborators. The study demonstrated that pediatric cancer diagnoses and mortality are significantly impacted in areas of armed conflict and documented the significant contribution these troubled areas make to the global burden of childhood cancer. The study’s findings provide data that can be used to support global policymaking and advocate for sustainable capacity-building in conflict-affected areas. The study was published today in The Lancet Oncology.
Armed conflicts worldwide are dangerous and disruptive, with ripple effects extending far beyond combat zones. Conflict can upend health care systems, leading to a lack of access to essential medical services, including cancer diagnosis and treatment. During armed conflict, hospitals may be damaged or destroyed, health care workers may be displaced, and vital medications often become scarce. This creates a perilous environment for children with cancer who are already vulnerable due to their illness.
“The impact of war on civilian health goes beyond immediate trauma; a major threat is the disruption of health care systems,” said co-senior author Asya Agulnik, MD, MPH, St. Jude Global Critical Care Program director and an associate member of the Department of Global Pediatric Medicine. “In high-resource settings, coordinated multidisciplinary care achieves an 85% survival rate for childhood cancer through timely diagnosis and treatment. However, in conflict-affected areas, these processes are severely compromised, leading to diagnosis and treatment delays and increased mortality risk. Importantly, while the incidence of childhood cancer is consistent globally, survival rates differ significantly due to these disruptions.”
Conflict increases pediatric cancer mortality rates
Researchers utilized data from the Global Burden of Disease (GBD) study and the Uppsala Conflict Data Program (UCDP). Those resources cover 1990 to 2019, providing a comprehensive overview of the impact of armed conflict and cancer outcomes for children aged 0-19 years. For their analysis, the researchers compared cancer mortality rates between countries in conflict (greater than or equal to 25 battle-related deaths per year) and those not (less than 25 battle-related deaths per year). Their findings revealed that over the three decades of study, more than half of all children diagnosed with cancer resided in countries experiencing armed conflict. Additionally, those cancer cases accounted for nearly 60% of childhood cancer deaths.
“The burden of pediatric cancer is disproportionately shifted not only to low-income countries but also countries in conflict. So, most childhood cancer cases and deaths occur in countries that are affected by conflict, and that proportion has been steadily increasing over time,” said Agulnik.
Countries experiencing armed conflict had an average mortality rate 20-30% higher than non-conflict countries each year.
“Our study found that even low levels of conflict detrimentally affect children’s cancer outcomes in those countries. We have to pay attention to not only the high levels of conflict picked up in the news, but also the smaller, more chronic levels of instability and conflict countries face when it comes to caring for children with cancer,” said corresponding and co-senior author Emily Smith, PhD, Duke University School of Medicine departments of Surgery and Emergency Medicine, and Duke Global Health Institute Center for Global Surgery and Health Equity.
A critical need for multidisciplinary interventions
By shedding light on this issue, the study advocates for developing novel targeted interventions and dedicated resources for these areas to address the unique challenges faced by children with cancer in environments plagued by conflict and instability. A sustainable approach is needed that builds local capacity to manage complex health needs, including training local providers and collaborating with the broader medical community to provide care. Focusing on capacity-building initiatives is essential for ensuring effective childhood cancer care amid ongoing instability.
“Children are a vulnerable population that often get caught up in conflicts, not of their own fault or doing. Our study shows that protecting them, particularly the most vulnerable with acute health conditions that require strong health systems, like cancer, is critical given the growing mortality rates in countries with conflict,” said Smith.
“This research is a great example of how multiple institutions can collaborate to tackle a complex issue,” added Agulnik. “It symbolizes the kind of multifaceted interventions needed to address this challenge. Solving it cannot be the work of a single entity; it requires diverse expertise from various sources, particularly from those on the ground.”
Authors and funding
The study’s other authors are Nickhill Bhakta and Taisiya Yakimkova, St. Jude; Pamela Espinoza and Henry Rice, Duke University School of Medicine; Paul Wise, Stanford University; Alexandra Mueller, University Medical Center Freiburg; and Lisa Force, University of Washington.
The study was supported by grants from the Bill and Melinda Gates Foundation, the Fogarty International Center (NIH IRSDA K01 TW012181), and ALSAC, the fundraising and awareness organization of St. Jude.
St. Jude Children's Research Hospital
St. Jude Children's Research Hospital is leading the way the world understands, treats and cures childhood cancer, sickle cell disease, and other life-threatening disorders. It is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. Treatments developed at St. Jude have helped push the overall childhood cancer survival rate from 20% to 80% since the hospital opened more than 60 years ago. St. Jude shares the breakthroughs it makes to help doctors and researchers at local hospitals and cancer centers around the world improve the quality of treatment and care for even more children. To learn more, visit stjude.org, read St. Jude Progress, a digital magazine, and follow St. Jude on social media at @stjuderesearch.