ArticleThe Lancet. Global health2023
Delays in cancer care for children in low-income and middle-income countries: development of a composite vulnerability index.
Article in The Lancet. Global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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31 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Clinical presentation of bone tumours in children and young people: a systematic review and meta-analysis.Archives of disease in childhood · 2025Pooled it
- Spatiotemporal analysis and socioeconomic determinants of pediatric lymphoid leukemias mortality in Brazil from 2000 to 2021: an ecological study.Lancet regional health. Americas · 2026Article
- Body composition changes and nutritional challenges in children with acute lymphoblastic leukaemia: Perspectives from low-resource settings.The Indian journal of medical research · 2026Review
- Global, regional, and national burden and changing trends of hepatoblastoma and retinoblastoma from 1990 to 2021, and projections until 2050: findings from the Global Burden of Disease Study 2021.Translational pediatrics · 2026Article
- Childhood cancer survival in Africa, Asia, Latin America and the Caribbean, during 2008-2017 (SURVCAN-3): a population-based benchmarking study of 16 821 children.Journal of the National Cancer Institute · 2026Article
- Multilevel onsite training and mentorship model to accelerate early childhood cancer diagnosis in Northwest Ethiopia: A quasi-experimental mixed method study.PLoS medicine · 2026Article
- Cancer survival and its social determinants among children with a migrant background: systematic review protocol.BMJ open · 2026Article
- Childhood cancer care in Northern Tanzania: hospital infrastructure and provision of services.Frontiers in pediatrics · 2026Article
- Global determinants of cervical cancer outcomes: a health systems analysis.BMJ oncology · 2026Article
- "From misdiagnosis to precision medicine: strengthening pediatric neuro-oncology care in LMICs toward equitable pLGG outcomes".Frontiers in oncology · 2026Review
- Prospective Psychometric Validation of the Swahili Translated and Adapted Pediatric Patient Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (Ped-PRO-CTCAE).Measurement and evaluations in cancer care · 2025Article
- Childhood cancer survival in low- and middle-income countries and the Global South: emerging evidence and critical gaps from a scoping review of observational studies.EJC paediatric oncology · 2025Review
- Browser-Based Multi-Cancer Classification Framework Using Depthwise Separable Convolutions for Precision Diagnostics.Diagnostics (Basel, Switzerland) · 2025Article
- Landscape assessment to characterize baseline access and multilevel barriers to IMProve Access to CAR-T CD19 therapy (IMPACT study) across Europe.medRxiv : the preprint server for health sciences · 2025Article
- Global cancer mortality among children, adolescents, and young adults from 77 countries, 1990-2021: a global time-series analysis and modelling study.World journal of pediatrics : WJP · 2025Article
- Overcoming the blood-brain barrier (BBB) in pediatric CNS tumors: immunotherapy and nanomedicine-driven strategies.Medical oncology (Northwood, London, England) · 2025Review
- National cancer system metrics and leukemia outcomes: an analysis of global data for pediatric and adult patients.Leukemia · 2025Article
- Epidemiology of multimorbidity in childhood cancer survivors: a matched cohort study of inpatient hospitalisations in Western Australia.BJC reports · 2025Article
- Global view of haematolymphoid tumor classifications and their application in low- and middle-income countries.Histopathology · 2025Review
- Impact of out-of-pocket expenses on children with cancer in Tanzania: A mixed-methods economic study.PloS one · 2025Article
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8 authors.
Funding
Abstract
backgroundEarly access to diagnosis and care is essential to improve rates of survival from childhood cancer, particularly in low-income and middle-income countries (LMICs). Composite indices are increasingly used to compare country performance in many health fields. We aimed to develop a composite vulnerability index of risk of mortality associated with delays in care for childhood cancer in LMICs, and to compare the vulnerability index scores across countries.
methodsThe composite vulnerability index was built in ten steps. A previous systematic review of determinants of delays in cancer care for children guided data selection. We collected exposure variables (determinants of delays in care) and outcome variables (childhood cancer-related mortality) from several large datasets. Data were analysed with regression models to identify determinants of delays in care that contribute to childhood cancer mortality. Significant indicators were aggregated into domains according to the socio-ecological model. We used geospatial tools to summarise and compare the composite vulnerability index scores across countries.
findingsWe found that life expectancy, maternal education, fertility rate, availability of pathology services, bone marrow transplantation capacity, availability of treatment services (chemotherapy, radiotherapy, or surgery), number of pharmacists per 10 000 population, country income level, and out-of-pocket health expenditure were significantly associated with cancer mortality for children in LMICs. The highest levels of vulnerability were found in sub-Saharan Africa.
interpretationOur composite vulnerability index can potentially serve as a valuable policy decision tool to help monitor country performance and guide interventions to reduce delays in care for children with cancer in LMICs.
fundingNone. TRANSLATIONS: For the Chinese, Portuguese, Arabic, Spanish and Swahili translations of the abstract see Supplementary Materials section.
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