Sustaining innovation and improvement in the treatment of childhood cancer: lessons from high-income countries
Sustaining innovation and improvement in the treatment of childhood cancer: lessons from high-income countries
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DOI：
10.1016/s1470-2045(13)70010-x
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发表时间：
2013-03-01
期刊：
影响因子：
51.1
通讯作者：
Steliarova-Foucher, Eva
中科院分区：
文献类型：
--
作者：
Pritchard-Jones, Kathy;Pieters, Rob;Steliarova-Foucher, Eva
儿童和青少年的癌症很少见，在生物学上与成人的癌症非常不同。它占全球所有癌症的1.4%，尽管这一比例从欧洲的0.5%到非洲的4.8%不等，主要是因为年龄构成和预期寿命的差异。在高收入国家，通过持续注重将临床研究纳入对几乎所有受恶性疾病影响的儿童的一线护理，儿童癌症存活率已达到80%。然而，进一步的改进必须需要新的生物学驱动的方法，因为传统治疗的优化在许多情况下已经达到了极限。在许多情况下，这种方法只能通过国际合作研究来实现，因为稀有癌症正在根据其分子特征被细分为越来越小的亚组。抗癌治疗对生活质量的长期影响也必须考虑在内，因为在高收入国家，每1000名成年人中就有超过1人被认为是儿童或青少年时期癌症的幸存者。引入比目前使用的药物毒性更小、更有针对性的药物，需要临床和转化研究人员、制药行业、药物监管机构、患者及其家属之间的合作。这一治疗联盟将确保努力集中在年轻癌症患者未满足的临床需求上。大多数患有癌症的儿童生活在低收入和中等收入国家，这些国家占0-14岁癌症死亡人数的94%。这些儿童的当务之急是在每个国家改善获得负担得起的最佳护理标准的机会。每个国家都应该制定一项国家癌症计划，认识到年轻癌症患者独特的人口特征和护理需求。将这些罕见疾病治疗的复杂组成部分集中起来，对于提高生存率、加快研究和培训未来的专家队伍至关重要。转诊路线和护理途径必须考虑到许多病人的家和治疗中心之间的地理距离，以及所服务人口的经济、文化和语言多样性。
Cancer in children and adolescents is rare and biologically very different from cancer in adults. It accounts for 1.4% of all cancers worldwide, although this proportion ranges from 0.5% in Europe to 4.8% in Africa, largely because of differences in age composition and life expectancy. In high-income countries, survival from childhood cancer has reached 80% through a continuous focus on the integration of clinical research into front-line care for nearly all children affected by malignant disease. However, further improvement must entail new biology-driven approaches, since optimisation of conventional treatments has in many cases reached its limits. In many instances, such approaches can only be achieved through international collaborative research, since rare cancers are being subdivided into increasingly smaller subgroups on the basis of their molecular characteristics. The long-term effect of anticancer treatment on quality of life must also be taken into account because more than one in 1000 adults in high-income countries are thought to be survivors of cancer in childhood or adolescence. The introduction of drugs that are less toxic and more targeted than those currently used necessitates a partnership between clinical and translational researchers, the pharmaceutical industry, drug regulators, and patients and their families. This therapeutic alliance will ensure that efforts are focused on the unmet clinical needs of young people with cancer. Most children with cancer live in low-income and middle-income countries, and these countries account for 94% of all deaths from cancer in people aged 0-14 years. The immediate priority for these children is to improve access to an affordable, best standard of care in each country. Every country should have a national cancer plan that recognises the unique demographic characteristics and care needs of young people with cancer. Centralisation of the complex components of treatment of these rare diseases is essential to improve survival, accelerate research, and train the future specialist workforce. Referral routes and care pathways must take account of the large geographical distances between many patients' homes and treatment centres, and the economic, cultural, and linguistic diversity of the populations served.