Department of Global health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston MA, USA.
Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
Lancet Oncol. 2020 Apr;21(4):e185-e224. doi: 10.1016/S1470-2045(20)30022-X.
We estimate that there will be 13·7 million new cases of childhood cancer globally between 2020 and 2050. At current levels of health system performance (including access and referral), 6·1 million (44·9%) of these children will be undiagnosed. Between 2020 and 2050, 11·1 million children will die from cancer if no additional investments are made to improve access to health-care services or childhood cancer treatment. Of this total, 9·3 million children (84·1%) will be in low-income and lower-middle-income countries. This burden could be vastly reduced with new funding to scale up cost-effective interventions. Simultaneous comprehensive scale-up of interventions could avert 6·2 million deaths in children with cancer in this period, more than half (56·1%) of the total number of deaths otherwise projected. Taking excess mortality risk into consideration, this reduction in the number of deaths is projected to produce a gain of 318 million life-years. In addition, the global lifetime productivity gains of US$2580 billion in 2020-50 would be four times greater than the cumulative treatment costs of $594 billion, producing a net benefit of $1986 billion on the global investment: a net return of $3 for every $1 invested. In sum, the burden of childhood cancer, which has been grossly underestimated in the past, can be effectively diminished to realise massive health and economic benefits and to avert millions of needless deaths.
我们估计，2020 年至 2050 年期间，全球将新增 1370 万例儿童癌症病例。在当前卫生系统绩效水平（包括获取和转诊）下，其中 610 万（44.9%）儿童将无法得到诊断。如果不增加投资以改善医疗保健服务获取或儿童癌症治疗，2020 年至 2050 年间，将有 1110 万儿童因癌症而死亡。在这总计死亡人数中，930 万（84.1%）儿童将来自低收入和中低收入国家。通过新的资金投入来扩大具有成本效益的干预措施，就可以大大减少这种负担。同时全面扩大干预措施，可以避免在此期间 620 万癌症儿童死亡，这比预计的总死亡人数多一半（56.1%）。考虑到超额死亡风险，预计死亡人数的减少将产生 3.18 亿个生命年的收益。此外，2020 年至 2050 年期间，全球的终身生产力收益将增加 2.58 万亿美元，是累计治疗费用 5940 亿美元的四倍，全球投资的净收益为 19860 亿美元，即每投资 1 美元就会产生 3 美元的收益。总之，过去被严重低估的儿童癌症负担可以得到有效减轻，从而带来巨大的健康和经济效益，并避免数百万人的不必要死亡。
