Journal Article

Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis

Acuna, Carlos, Devidas, Meenakshi, Ehrlich, Bella S, Wiphatphumiprates, Parima P, Pham, Linh T D, Duffy, Caitlyn, Aceituno, Alejandra Mendez, McNeil, Michael J, Rodriguez-Galindo, Carlos, Villegas, Cesar A, Agulnik, Asya, Force, Lisa M, Slone, Jeremy S, Chen, Yichen, Carrillo, Angela K, Rivera, Jocelyn, Sniderman, Liz, Bolous, Nancy S, Gillipelli, Srinithya R, Sakaan, Firas M, Arias, Anita V, Mukkada, Sheena

2023

Overview

Approximately 90% of children with cancer live in low-income and middle-income countries (LMICs), where 5-year survival is lower than 20%. Treatment-related mortality in high-income countries is approximately 3–5%; however, in LMICs, treatment-related mortality has been reported in up to 45% of children with cancer. This study aimed to systematically explore the burden of treatment-related mortality in children with cancer in LMICs and to explore the association between country income level and treatment-related mortality. For this systematic review and meta-analysis we identified articles published between Jan 1, 2010, and June 22, 2021, describing treatment-related mortality in paediatric patients (aged 0–21 years) with cancer in LMICs. We searched PubMed, Trip, Web of Science, Embase, and the WHO Global Metric Index databases. The search was limited to full-text articles and excluded case reports (<10 patients) and haematopoietic stem-cell transplantation recipients. Two reviewers independently screened studies for eligibility, extracted data from included publications, and evaluated data quality. Random and mixed-effects models were used to estimate treatment-related mortality burden and trends. The Cochran-Q statistic was used to assess heterogeneity between studies. This study is registered on PROSPERO (CRD42021264849). Of 13 269 identified abstracts, 501 studies representing 68 351 paediatric patients with cancer were included. The treatment-related mortality estimate was 6·82% (95% CI 5·99–7·64), accounting for 30·9% of overall mortality (4437 of 14 358 deaths). Treatment-related mortality was inversely related to country income. Treatment-related mortality was 14·19% (95% CI 9·65–18·73) in low-income countries, 9·21% (7·93–10·49) in lower-middle-income countries, and 4·47% (3·42–5·53) in upper-middle-income countries (Cochran-Q 42·39, p<0·0001). In upper-middle-income countries, the incidence of treatment-related mortality decreased over time (slope –0·002, p=0·0028); however, outcomes remained unchanged in low-income (p=0·21) and lower-middle-income countries (p=0·16). Approximately one in 15 children receiving cancer treatment in LMICs die from treatment-related complications. Although treatment-related mortality has decreased in upper-middle-income countries over time, it remains unchanged in LMICs. There is an urgent need for targeted supportive care interventions to reduce global disparities in childhood cancer survival. American Lebanese Syrian Associated Charities and National Cancer Institute.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Cancer therapies / Case reports / Child / Child mortality / Children / Developing Countries / Hematology, Oncology, and Palliative Medicine / Humans / Income / Industrialized nations / Leukemia / Meta-analysis / Mortality / Neoplasms - therapy / Patients / Pediatrics / Poverty / Sepsis / Stem cell transplantation / Systematic review / Toxicity / Transplants & implants