title: Global challenges in pediatric oncology.
abstract: OBJECTIVE
  Reduction of child mortality is one of the Millennium Development Goals; as low-income and middle-income countries (LMICs) advance toward the achievement of this goal, initiatives aimed at reducing the burden of noncommunicable diseases, including childhood cancer, need to be developed.
  
  
  RESULTS
  Approximately 200 000 children and adolescents are diagnosed with cancer every year worldwide; of those, 80% live in LMICs, which account for 90% of the deaths. Lack of quality population-based cancer registries in LMICs limits our knowledge of the epidemiology of pediatric cancer; however, available information showing variations in incidence may indicate unique interactions between environmental and genetic factors that could provide clues to cause. Outcome of children with cancer in LMICs is dictated by late presentation and underdiagnosis, high abandonment rates, high prevalence of malnutrition and other comorbidities, suboptimal supportive and palliative care, and limited access to curative therapies. Initiatives integrating program building with education of healthcare providers and research have proven to be successful in the development of regional capacity. Intensity-graduated treatments adjusted to the local capacity have been developed.
  
  
  CONCLUSIONS
  Childhood cancer burden is shifted toward LMICs; global initiatives directed at pediatric cancer care and control are urgently needed. International partnerships facilitating stepwise processes that build capacity while incorporating epidemiology and health services research and implementing intensity-graduated treatments have been shown to be effective.
authors.affiliation: Division of Hematology-Oncology, Dana-Farber/Children's Hospital Cancer Center, Boston, Massachusetts, USA. carlos_rodriguezgalindo@dfci.harvard.edu
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez-Galindo
authors.forename: Paola
authors.initials: P
authors.lastname: Friedrich
authors.forename: Lisa
authors.initials: L
authors.lastname: Morrissey
authors.forename: Lindsay
authors.initials: L
authors.lastname: Frazier
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D003906:Developing Countries; D014943:Global Health; D006801:Humans; D007391:International Cooperation; D008495:Medical Oncology / Q000193:education; D008507:Medically Underserved Area; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy*; D016730:Program Development / Q000379:methods