On the contrary, in low and middle-income countries, hope dims drastically as the survival rate can plummet to less than 30%1. To uncover the factors driving these stark inequalities and gain a better understanding of how to narrow that survival gap, Insights teams spoke with Divya Sachdev, Director of World Child Cancer USA. Since 2007, this organization has demonstrated an unwavering commitment to building a world where every child with cancer has equal access to the best possible treatment and care, igniting hope for countless families all over the world.
Measuring the childhood cancer survival gap
Insights: Dear Divya, thank you for your time. To start this interview, could you tell us a little bit more about the main factors contributing to the persistence of these inequalities in childhood cancer treatment?
Divya Sachdev, Director of World Child Cancer USA
Divya Sachdev: Of course. A number of factors are clearly identifiable as contributing to the ongoing survival disparities in childhood cancer survival rates between high-income countries and low-income and middle-income countries. These factors affect every stage of pediatric cancer care, from diagnosis to treatment and long-term survival.
The primary factor is the low rate of cancer diagnosis, largely due to a lack of awareness from healthcare professionals who are often unaware of the upward trajectory of pediatric cancers. Most of them have never been trained to identify and diagnose childhood cancer.
The second factor is the lack of access to treatment. Many low- and middle-income countries have not yet developed the basic infrastructure to care for children with cancer. Hospitals are often under-resourced, and there is a severe shortage of pediatric oncologists preventing children from receiving timely or appropriate treatment.
Finally, one of the most significant challenges in low and middle-income countries is fighting the treatment abandonment driven by a range of social and economic factors. Some children live hundreds of kilometers away from the hospital and cannot afford an accommodation close to the hospital. In Myanmar for instance, the average travel time to the hospital for families is 12 hours3. In some cases, children are also the primary earners for their families. Pursuing treatment means losing their job and plunging their entire family into extreme poverty, an unimaginable choice.
Finally, one of the most significant challenges in low and middle-income countries is fighting the treatment abandonment driven by a range of social and economic factors. Some children live hundreds of kilometers away from the hospital and cannot afford an accommodation close to the hospital. In Myanmar for instance, the average travel time to the hospital for families is 24 hours3. In some cases, children are also the primary earners for their families. Pursuing treatment means losing their job and plunging their entire family into extreme poverty, an unimaginable choice.
Insights: The World Health Organization (WHO) has set a global target to achieve a 60% childhood cancer survival rate by 20301, with the goal of saving one million lives. As a partner of the WHO Global Initiative for Childhood Cancer, World Child Cancer is actively working towards achieving this goal. What is your strategy to reach it?
D.S: Our strategy is based on four distinct pillars. Each of these pillars is designed to overcome the barriers that reduce children’s chances of survival that I previously mentioned. The first pillar focuses on a critical goal: increasing the cancer diagnosis rate in low and middle-income countries to give children a better chance to fight cancer early. The earlier the treatment starts, the higher their chances of survival are.
To increase that rate, we train more than 3500 health professionals each year, with a special focus on early warning signs and symptoms. We run awareness campaigns at the local level, ensuring to work hand-in-hand with local communities and key local players such as social workers and local doctors. The Early Warning Campaign that we conducted in 2020 in Ghana is a perfect example of our approach. We equipped the frontline health workers with knowledge to recognize the early warning signs of cancer and refer children for appropriate care. It resulted in a 28%4 increase in diagnosis, thus saving many children’s lives.
“Behind every increase in the diagnosis rate are children who now have the chance to live long, healthy lives with bright futures ahead of them.”
The second pillar boils down to providing financial and emotional support to children and families. Our mission extends far beyond providing cancer treatments to children, it is about standing by their side through every challenge they will face after the diagnosis.
“We deliver comprehensive support to enable families to focus on what matters the most: being there for their child.”
We deliver comprehensive support to help them navigate and overcome the financial, emotional and practical obstacles to accessing treatment and staying committed to it. We cover the cost of the treatment, travel and care and provide them with accommodation near the hospital so that the families can focus on what matters the most: being there for their child. We also design and offer tailored emotional support such as play therapy.
D.S: Additionally, we train healthcare professionals in palliative care to ensure that children who cannot be cured can leave this world without pain and with dignity.
The third pillar of our strategy is to improve the quality of childhood cancer care. We strive to deliver children with cancer with the best possible treatment and care. In 2023, we shipped essential drugs with a total equivalent value of $3.8 million. Beyond improving the quality of treatment, we take a holistic approach to patient care, with a particular focus on areas such as mental health or nutrition.
The last pillar of our strategy is to influence policies and public opinion and to shed light on the urgent need to bridge the survival gap. Advocacy at every level is a big part of our work and we strive every day to ensure that childhood cancer is at the forefront of the agendas worldwide. We put a particular focus on building connections at every level.
We are convinced that joining forces with partners who will champion our cause at every level will be fruitful to our cause. At international level, we work closely with international bodies like WHO and with companies who have the power to bring about a real change thanks to their worldwide footprint. But building connections at the local level, with key local players like local doctors and social workers is just as essential to raise families’ awareness about cancer and gain their trust.
“We need to join forces with partners who will champion our cause at every level.”
“This survival gap between higher income and low- and middle-income countries is unacceptable. As doctors, we have the research, the knowledge and the treatments to bring survival rates closer to those in higher income countries and we must act now.”
Docteur John van Doorninck, a pediatric oncologist at Rocky Mountain Hospital for Children in Denver, United States, and Co-Chair of the World Child Cancer Global Medical Program Committee
Insights: World Child Cancer was founded in 2007. Which progress have you already noticed over the years?
“Our mission extends beyond simply enabling children to access treatment. It is rooted in a holistic approach of patient care that focuses on enhancing the overall quality of life for children with cancer.””
D.S: Since our founding in 2007, I am proud to say that we have made remarkable progress in narrowing the childhood cancer survival gap thanks to the unwavering commitment of our teams and partners. Overall, we have helped over 50.000 beneficiaries. Among which, 7000 children in 2023 alone. I would like to highlight one of the key turning points of our journey that is of particular importance to me: the shift towards a more comprehensive approach. We are now able to focus on improving the quality of life of children and their families, not just on the treatment itself.
Insights: What personally gives you hope that the pediatric cancer survival gap can be significantly reduced in the coming years?
D.S: Witnessing the growing interest in pediatric cancer is truly heartening to me. The mobilization now extends beyond governments and public authorities. Civil society and the private sector are increasingly stepping up to champion that cause. I am strongly convinced that those concerted efforts will result in saving more and more children’s lives in the coming years.
Another thing that personally gives me a lot of hope is seeing the local ecosystems empowering themselves in countries where World Child Cancer operated. A key indicator of success is when low- and middle-income countries are able to independently manage their own healthcare and social care systems locally Ghana is a perfect example of that journey. In 2019, it became one of our centers of excellence. The country is now empowering the whole Sub-Saharan region, striving to ensure that every child diagnosed with cancer has a chance at a healthy future. That vision truly fills me with hope.
“A key indicator of success is when low and medium income countries no longer need to rely on high-income countries to care for their children with cancer.”
Biography:
Divya Sachdev has been with World Child Cancer USA since 2022, leveraging over a decade of global nonprofit experience. With a strong belief in the “Head, Heart, Hand” approach, she emphasizes the importance of creating systemic change that endures beyond individual efforts. Throughout her career, Divya has spearheaded initiatives in skill development, education, and child welfare, both in India and the USA. Her passion for empowering vulnerable communities drives her commitment to ensuring every child has access to opportunities that promote a brighter, healthier future. She has a MBA from Bocconi University and Cornell University in General Management. In addition to her professional pursuits, Divya is an advocate for mentorship, actively supporting emerging talent in social impact.
[1] WHO – Chidhood Cancer – Key facts, consulté le 15/01 https://www.who.int/news-room/fact-sheets/detail/cancer-in-children
[2] NIH -Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis, https://pubmed.ncbi.nlm.nih.gov/37517410/
[3] World Child Cancer – Myanmar, consulté le 15/01 https://worldchildcancer.org/myanmar/
[4] World Child Cancer – Early diagnosis of childhood cancer, consulté le 15/01 https://worldchildcancer.org/early-diagnosis-childhood-cancer/