Molyneux Elizabeth, Scanlan Trish, Chagaluka George, Renner Lorna
College of Medicine, Blantyre, Malawi.
Muhimbhili Hospital, Dar es Salaam, Tanzania.
Br J Haematol. 2017 Jun;177(6):971-978. doi: 10.1111/bjh.14617.
Cancer is increasingly important in low and middle-income settings where infectious diseases are declining. Childhood cancers treated in well-resourced centres have excellent outcomes with more than 80% survival. This success is not reflected in low-income settings where challenges involve every step on the care pathway. Access to diagnosis, delayed presentation, advanced disease, co-morbidities and underlying malnutrition make treatment difficult. Treatments are costly for impoverished families. Yet, the common haematological malignancies (Burkitt lymphoma, Hodgkin lymphoma, non Hodgkin lymphoma) are relatively easy to diagnose and, when managed with simple chemotherapy protocols, give limited but good results. As funding becomes available for cancer research we must ensure that the care and cure of these children is top of the agenda. There is already evidence of improved outcomes in middle-income countries. For others there is a long journey ahead.
在传染病发病率不断下降的低收入和中等收入地区，癌症正变得越来越重要。在资源丰富的中心接受治疗的儿童癌症患者预后良好，生存率超过80%。然而，在低收入地区，这种成功并未得到体现，因为在护理过程的每一步都面临挑战。获得诊断的机会、就诊延迟、疾病进展、合并症以及潜在的营养不良都使得治疗变得困难。对于贫困家庭来说，治疗费用高昂。然而，常见的血液系统恶性肿瘤（伯基特淋巴瘤、霍奇金淋巴瘤、非霍奇金淋巴瘤）相对容易诊断，并且采用简单的化疗方案进行治疗时，虽效果有限但也不错。随着癌症研究资金的到位，我们必须确保这些儿童的护理和治愈是首要议程。在中等收入国家已经有证据表明治疗效果有所改善。而对于其他国家来说，还有很长的路要走。
