AIIMS, Delhi, Review Maps Childhood Cancer Survival

Survival rates among children with cancer in India vary widely across different types of the disease, with some childhood cancers now recording outcomes comparable to global standards while others continue to have significantly lower survival, according to the first comprehensive national review led by AIIMS, Delhi.

Among childhood blood cancers, acute lymphoblastic leukaemia (ALL) recorded an estimated five-year overall survival of 67.1 per cent, while acute myeloid leukaemia (AML) showed a considerably lower three-year survival of 60.9 per cent. In contrast, chronic myeloid leukaemia (CML) recorded one of the highest survival rates at 97 per cent over three years.

Among solid tumours, Hodgkin lymphoma showed the best outcomes, with a five-year survival of 93.1 per cent. Wilms tumour, a childhood kidney cancer, recorded 78.8 per cent five-year survival, while retinoblastoma, an eye cancer that is highly curable when detected early, showed 76.8 per cent.

Published in JCO Global Oncology, the AIIMS-led review analysed three decades of published evidence from treatment centres across India, synthesising findings from 182 studies involving 22,886 children. Researchers screened 6,802 studies published until December 2023 before including those that met quality criteria. Led by Dr. Sameer Bakhshi of AIIMS New Delhi, the study was conducted in collaboration with CanKids…KidsCan, the World Health Organization (WHO), St. Jude Children's Research Hospital in the United States and other international partners.

The review provides policymakers with India's first consolidated baseline of childhood cancer survival, enabling them to identify treatment gaps, strengthen accountability and monitor progress as the country works to improve outcomes for children with cancer.

However, the analysis also highlights significant disparities. Children with extraocular retinoblastoma, in which the cancer spreads beyond the eye, had a pooled two-year survival of only 44.9 per cent, underscoring the impact of delayed diagnosis and advanced disease.

Outcomes were also less favourable for several aggressive childhood cancers. Neuroblastoma, a cancer of immature nerve cells, recorded a three-year survival of 56.9 per cent, while osteosarcoma, a bone cancer, had 60.3 per cent survival over the same period.

For some cancers, researchers reported median rather than long-term survival rates. Medulloblastoma, the most common malignant brain tumour in children, had a median overall survival of 43.9 months, while Ewing sarcoma, an aggressive bone cancer, had a median survival of 21.2 months.

Calling it the first comprehensive synthesis of childhood cancer survival data from India, Dr. Sameer Bakhshi, Professor and Head of Medical Oncology at AIIMS New Delhi, said the review fills a major evidence gap.

"This review is the first comprehensive synthesis of published childhood cancer survival evidence from India. By systematically bringing together three decades of data from centres across the country, it establishes an important evidence base for understanding survival across different childhood cancers while identifying critical gaps in knowledge," he said.

Dr. Bakhshi said the findings should encourage stronger cancer registries, multicentre collaborative research and standardised outcome reporting.

"We hope this work will stimulate stronger cancer registries, multicentre collaborative research and standardised outcome reporting, enabling India to measure progress more effectively and continuously improve outcomes for children with cancer," he added.

Experts said the findings assume added significance as India aligns its childhood cancer strategy with the WHO Global Initiative for Childhood Cancer, the United Nations General Assembly's 2030 goals, and Universal Health Coverage.

Poonam Bagai, Founder-Chairman of CanKids… KidsCan said India's goals are 100 per cent access to care, 100 per cent financial protection and at least 60 per cent survival for children with cancer.

"The importance of this study goes beyond the individual survival estimates. Without a survival evidence baseline, how could we measure progress, identify where children were still being left behind, or determine where treatment quality, supportive care, continuity of care and financial protection needed urgent strengthening?" she asked.

Former NITI Aayog Member (Health) Dr. Vinod Paul described the review as a landmark contribution to childhood cancer care.

"A patient-centred system must measure not only whether a child reaches treatment but also whether the child remains in care, completes treatment, survives and thrives," he said.