Al Lamki Zakiya
College of Medicine & Health Sciences, Sultan Qaboos University, Muscat. Oman.
Curr Pediatr Rev. 2017;13(1):13-23. doi: 10.2174/1573396312666161230145417.
Cancer is a global health problem particularly in developing countries where the burden of cancer is ever increasing and claiming the lives of about 100,000 children under the age of 15 years every year. Majority of these occur in the Low and Middle Income Countries (LMICs) where 90% of world children live. Contributing factors to this trend is the reduction of communicable diseases and emergence of new infections, improvement of nutrition and socio-economic conditions, industrialization and urbanization. However, due to its complexity, childhood cancer is given the least priority by the governments' funding. The weak health systems, poor and late access to diagnosis and care, fewer numbers of trained health care professionals and lack of cancer drugs are amongst the many challenges faced. A major challenge for the future is extending the work to reach the many children who die without access to cancer treatment and palliation. Given the inequalities in the survival rates of children with cancer there is therefore an urgent need to close the gap between developed and developing countries. Strategies at individual, institutional, country, regional and global levels must be implemented to improve cancer survival and its effects on human suffering. These strategies are able to strengthen the health systems, improve care and research, increase awareness and coordinate training of professionals thus meeting the challenges. Financial support should be an integral part of the strategy as the cost of drugs is often a substantial barrier to treatment of cancer in poor countries. However, in resource-limited settings without specialized services, much can still be done to support and offer curative and palliative treatment. As have been shown for several cancers, life can be extended with low-tech treatment protocols, which are effective at the same time, decrease sepsis and toxicity. The concept of twinning with privileged nations is paramount to the success of any national cancer program. International partnership offers the opportunity to provide expertise, advice, support and transfer technology from established pediatric oncology unit. Their mission is to build capacity for cancer treatment and research with a vision of developing network of dedicated advocates. The LMIC teams must locally drive projects and volunteers and funding organizations can help to make progress possible. This will require a tremendous effort on the part of both high and low-middle-income countries, if we are all to work together to achieve this goal.
癌症是一个全球性的健康问题，在发展中国家尤为突出，那里的癌症负担不断增加，每年约有10万名15岁以下儿童因此丧生。其中大多数病例发生在低收入和中等收入国家（LMICs），全球90%的儿童生活在这些国家。导致这一趋势的因素包括传染病减少和新感染的出现、营养和社会经济条件的改善、工业化和城市化。然而，由于其复杂性，儿童癌症在政府资金投入中最不受重视。卫生系统薄弱、诊断和治疗的可及性差且延迟、受过培训的医疗保健专业人员数量较少以及缺乏抗癌药物等都是面临的诸多挑战。未来的一个主要挑战是将工作扩展到许多无法获得癌症治疗和姑息治疗而死亡的儿童。鉴于癌症儿童生存率存在不平等现象，因此迫切需要缩小发达国家和发展中国家之间的差距。必须在个人、机构、国家、区域和全球层面实施战略，以提高癌症生存率并减轻其对人类痛苦的影响。这些战略能够加强卫生系统、改善护理和研究、提高认识并协调专业人员的培训，从而应对挑战。财政支持应成为战略的一个组成部分，因为药物成本往往是贫困国家癌症治疗的一个重大障碍。然而，在没有专业服务的资源有限环境中，仍然可以做很多工作来支持并提供治愈性和姑息性治疗。正如几种癌症所显示的那样，采用低技术治疗方案可以延长生命，这些方案同时有效，可减少败血症和毒性。与富裕国家结对的概念对于任何国家癌症计划的成功至关重要。国际伙伴关系提供了提供专业知识、建议、支持以及从成熟的儿科肿瘤学单位转让技术的机会。其使命是建设癌症治疗和研究能力，目标是发展一个由专门倡导者组成的网络。低收入和中等收入国家的团队必须在当地推动项目，志愿者和资助组织可以帮助推动取得进展。如果我们要共同努力实现这一目标，这将需要高收入国家和中低收入国家付出巨大努力。
