“We must strive to cure more children but also to inflict less life-long harm.”
The steady improvement in survival of children and adolescents with cancer in the past 50 years is one of the major victories of modern medicine.
Although certain childhood malignancies have seen little or no progress in the past 25 years, and redoubled effort is certainly necessary for these diseases, more than 80% of children diagnosed with cancer in high-income countries can now expect long-term cure.
This extraordinary success has resulted in an ever-expanding population of paediatric cancer survivors, projected to reach 500 000 people in 2020 in the USA alone. However, most survivors face a lifetime of medical issues; more than 80% of survivors live with at least one severe, disabling or life-threatening health condition. The life expectancy of survivors is shortened on average by 10 years compared with healthy individuals, roughly equivalent to the decrement in the life expectancy caused by smoking.
The chance for cure is not equally distributed across the population. Vulnerable subgroups, including children from low-income families or non-white households, have outcomes far inferior to those achievable. Adolescents and young adults, as a group, have inferior outcomes compared to those of younger children. Broadening the lens, the proportions of cure for children living in low-income and middle-income countries (LMICs) lag far behind those in high-income countries.
Cancer Moonshot is an unprecedented opportunity to galvanise the paediatric oncology community, catalyse further dramatic improvements in curative treatment, and reduce the short-term and long-term toxic effects of cancer and its therapy.