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Over the past decade, the global scientific community has increasingly focused on understanding survival outcomes among patients with cancer, particularly in pediatric and adolescent populations1. This growing attention reflects a pressing concern: the persistent disparities in survival rates for children and adolescents with cancer, especially in low- and middle-income countries (LMICs), where multifaceted barriers to healthcare access remain a major challenge5.
Malignant neoplasms in individuals aged 0 to 19 years account for approximately 1–4% of all cancer cases in most countries. However, in regions where children represent a significant proportion of the population—such as LMICs—this burden may rise to as much as 10%6. Despite global advances in pediatric oncology, stark contrasts remain. In high-income countries (HICs), up to 80% of children diagnosed with cancer can be cured, largely due to early detection and access to specialized care. Conversely, children in LMICs are nearly four times more likely to die from the disease, primarily due to delayed diagnosis, limited access to treatment, and insufficient supportive care5,9.
The critical factors underlying this gap include: (i) diagnostic delays and fragmented access to care, (ii) late-stage disease at presentation, (iii) limited availability of evidence-based treatment protocols and skilled professionals, and (iv) high rates of treatment abandonment resulting from the financial and social burdens placed on families10,11. Despite these disparities, it is estimated that over 90% of all childhood cancer cases occur in LMICs, where systems often lack the resources to provide timely and comprehensive care6,9,12.
Positioning childhood cancer as a priority in the public health agenda is not only feasible but also cost-effective and impactful. Such prioritization represents a unique opportunity to reduce preventable mortality and suffering while reinforcing strategies for the broader control of noncommunicable diseases (NCDs)13-15.
In response to these global disparities, the World Health Organization (WHO), in partnership with the International Agency for Research on Cancer (IARC) and other UN entities, launched the Global Initiative for Childhood Cancer (GICC) in 2018. This initiative seeks to ensure that every child with cancer—regardless of geographic location or cancer type—has access to timely diagnosis, high-quality treatment, and comprehensive supportive care, thereby enabling them to live not only longer but also with dignity and quality of life14,15. The GICC aligns with the targets of the WHO Global Action Plan for the Prevention and Control of NCDs and the United Nations 2030 Agenda for Sustainable Development. One of its central goals is to increase global survival rates for childhood cancer to at least 60% by the year 2030. To achieve this, the initiative emphasizes two main priorities: (i) strengthening country-level capacity to provide high-quality pediatric oncology services, and (ii) integrating childhood cancer into global, regional, and national cancer control agendas5.
To operationalize these aims, the WHO introduced the CureAll Framework, a strategic model that supports countries in strengthening their health systems across the entire continuum of care. The framework is built upon four foundational pillars—Centers of excellence and care networks, Universal health coverage, Regimens for evidence-based diagnosis and treatment, and Evaluation and monitoring—and three key enablers: Advocacy, Leveraged financing, and Linked governance5, as shown in Figure 1.
This comprehensive package enables governments and stakeholders to design and implement context-specific, sustainable solutions to reduce inequities, enhance early detection and treatment outcomes, and address the long-term consequences of cancer therapies in children and adolescents. It also offers a unique opportunity for countries to accelerate action and monitor progress toward the elimination of avoidable childhood cancer deaths, particularly in resource-constrained settings.
Implications for Global Health Systems
In Latin America, pediatric cancer care remains highly heterogeneous due to the region’s diversity in health system organization, resource allocation, care delivery models, and population needs16. Compounding this complexity is the limited availability and quality of epidemiological data across many countries, especially regarding incidence, survival, and mortality. These limitations in cancer registration and surveillance constrain regional comparability and hinder the formulation of evidence-informed policies9,11.
Similar to global trends, leukemia is the most common childhood cancer across Latin American countries, followed by central nervous system (CNS) tumors. However, survival outcomes for pediatric acute lymphoblastic leukemia (ALL) are markedly variable. Five-year relative survival rates range from as low as 49.8% in Ecuador to over 93% in Puerto Rico, highlighting disparities both within and across nations17.
A particularly pressing challenge in several Latin American countries is the shortage of pediatric hematologists and oncologists, which contributes to diagnostic delays, long travel distances for treatment—sometimes even to neighboring countries—and the use of non-standardized treatment protocols4,15,18. These systemic constraints directly impact patient survival and treatment continuity.
Despite substantial gains in pediatric cancer outcomes in high-income countries over the past decades—considered one of modern medicine's greatest achievements—these improvements have not been equitably replicated in low- and middle-income countries (LMICs)17. In many LMICs, reliable data on pediatric cancer incidence and outcomes are either incomplete or absent, largely due to the lack of population-based cancer registries and functioning vital statistics systems required to generate accurate estimates6,9,13,19.
An international study analyzing mortality trends in childhood cancer across the Americas and Australasia found steady annual reductions of 2–3% in Australasia, 1.5–2% in North America and Chile, and about 1% in Argentina. However, other Latin American countries did not show substantial improvements20. Mortality rates for leukemia declined in most settings, but less favorable trends were observed for CNS tumors, especially in Latin America. In 2016, mortality from all childhood cancers ranged from 4–6 per 100,000 boys and 3–4 per 100,000 girls in Latin America, compared to lower rates of 2–3 per 100,000 in boys and approximately 2 per 100,000 in girls in North America and Australasia20.
Unlike adult cancers, pediatric malignancies are not amenable to population-based screening or prevention through lifestyle interventions. Their outcomes instead depend critically on timely and accurate diagnosis, appropriate treatment, and access to specialized care10. Therefore, increasing survival in these populations will require strategic investments in health system planning and governance, particularly in LMICs7.
Robust, high-quality data on cancer incidence and outcomes are foundational to the design and implementation of national and regional cancer control strategies. Population-Based Cancer Registries (PBCRs), Hospital-Based Cancer Registries (HBCRs), and national mortality surveillance systems represent the cornerstone infrastructure for monitoring trends, guiding public health responses, and prioritizing research and resource allocation in oncology13,14, 21-23.
Bridging the Gap: Regional Action for the CureAll Framework in Latin America and the Caribbean
While high-income countries (HICs) such as the United States have achieved childhood cancer survival rates nearing 85% over recent decades8, this progress remains unevenly distributed across the globe. In Latin America and the Caribbean (LAC), wide disparities persist and, in some cases, are widening, driven by systemic limitations in healthcare infrastructure, access to timely diagnostics, and continuity of care24,25. In low- and middle-income countries (LMICs), where approximately 80% of all childhood cancer cases occur, preventable deaths often stem from late diagnosis, misdiagnosis, treatment abandonment, malnutrition, toxicity-related complications, and limited access to effective therapeutic protocols12, 26, 27.
In response to this pressing inequity, the Pan American Health Organization (PAHO), in collaboration with St. Jude Children’s Research Hospital and a broad network of regional partners, has prioritized efforts to enhance pediatric cancer outcomes in the LAC region5,24. As part of its commitment to accelerate the implementation of the WHO Global Initiative for Childhood Cancer (GICC), PAHO has fostered the creation of context-sensitive, culturally relevant technical resources aligned with the CureAll Framework, which provides a strategic roadmap for improving childhood cancer care through systemic action4,11, 24.
Beginning in early 2021, PAHO convened multidisciplinary working groups to address the leading barriers to care and to promote collaborative solutions tailored to regional needs. These efforts culminated in the establishment of seven technical groups focused on early detection, pediatric oncology nursing, psychosocial care, nutrition, supportive care, treatment abandonment, and palliative care. Regular virtual dialogues—organized with support from PAHO programs, St. Jude global mentors, and international stakeholders—ensured knowledge exchange and regional ownership throughout the process4,11, 24.
Between April and December 2021, a total of 202 professionals from diverse disciplines participated in 43 collaborative meetings, generating a suite of 14 regionally focused resources. These included: (i) four regional situation analyses; (ii) four technical guidance documents; (iii) two online training courses; (iv) a collection of national epidemiological profiles; (v) educational materials for caregivers and families; and (vi) two regional awareness campaigns4,11, 24.
The CureAll-aligned approach promoted by PAHO and its collaborators reflects a model of sustained regional engagement, grounded in the principles of equity, capacity building, and systems strengthening. These technical products represent both the tangible outputs of the Global Initiative in the Americas and a replicable model for other regions seeking to advance pediatric cancer control.
Nonetheless, ongoing research and implementation science efforts are needed to evaluate the real-world impact of these strategies on survival outcomes, treatment adherence, and quality of care. Continuous monitoring, stakeholder feedback, and adaptive learning will be critical to ensure the long-term success and scalability of the GICC’s objectives across varying national contexts.
Strategic Implementation of the CureAll Framework: Guidance for Policymakers and Program Managers
Political will remains one of the most decisive enablers in expanding access to timely and effective care for children and adolescents with cancer. Elevating childhood cancer on national health agendas depends heavily on sustained advocacy directed at decision-makers. Local authorities and policymakers are uniquely positioned to influence legislation, mobilize funding, and integrate cancer control measures into national health plans4,5.
Effective advocacy strategies must engage a broad spectrum of stakeholders—including patient organizations, professional societies, and civil society—to create unified demands for action. This includes conducting and disseminating situational analyses at the national and regional levels, aligning advocacy with existing policies and global frameworks, and using media and communication platforms to generate public awareness. When advocacy successfully fosters political prioritization, it can catalyze systemic change through increased budgetary allocations, policy reform, and service delivery improvements5,11,24.
A growing body of evidence from LMICs has identified the key determinants of poor outcomes in pediatric cancer, including delayed or missed diagnosis28, treatment abandonment29, malnutrition30, understaffing of nursing teams31, and insufficient access to supportive and palliative care services32. These findings underscore the need for evidence-informed policymaking to reduce preventable mortality and improve quality of life for children affected by cancer.
To that end, policymakers must recognize and respond to these determinants by implementing integrated solutions. For example, policies promoting early warning signs recognition and timely referrals can help reduce delays in diagnosis. Similarly, integrating nutritional support and psychosocial care into treatment protocols can mitigate toxicities and improve adherence. Data derived from country-specific childhood cancer profiles, regional technical reports, and national situation assessments provide valuable insights to inform where investments are most urgently needed4,11.
In parallel, the development and dissemination of technical resources aimed at healthcare professionals are essential for translating policy into practice. Guidelines, virtual training modules, and clinical protocols—tailored to the local context—empower frontline providers to deliver care that is both evidence-based and culturally appropriate4. These resources support the consistent implementation of the CureAll pillars by standardizing clinical pathways and strengthening workforce capacity.
Despite increasing awareness, pediatric cancer continues to receive insufficient attention in many LAC countries. The region bears a high burden of morbidity and mortality from childhood cancers, yet access to services remains fragmented and inequitable, resulting in substantial disparities in outcomes across and within countries4,11. Addressing this gap requires more than isolated initiatives; it demands cohesive, system-level reforms that embed childhood cancer control into broader child health and noncommunicable disease strategies.
Integrating childhood cancer into national public health agendas is not only critical for improving survival but also for strengthening health systems more broadly. Targeted, context-sensitive implementation of the CureAll framework offers a powerful opportunity to build more equitable, resilient, and responsive systems of care for all children, regardless of where they live.
Concluding Remarks and Future Directions
The WHO Global Initiative for Childhood Cancer, through the CureAll Framework, represents a turning point in the global response to childhood cancer. By prioritizing equitable access to timely diagnosis, standardized treatment, and comprehensive supportive care, the initiative offers a scalable model to reduce disparities and improve survival outcomes—particularly in low- and middle-income countries, where the burden is greatest and resources remain limited.
The Latin America and Caribbean (LAC) region has demonstrated significant momentum in advancing the goals of the initiative, with the development of technical resources, formation of regional working groups, and growing political commitment. However, progress is still uneven. Continued success will require sustained investment in health systems, robust data collection through cancer registries, and coordinated multisectoral action that extends beyond the health sector.
As global childhood cancer survival improves, the imperative is not only to treat but to do so with equity, dignity, and quality. Governments, donors, healthcare institutions, and civil society must align efforts to ensure that no child is left behind due to where they live or the limitations of their healthcare system.
To achieve this, we recommend the following strategic actions:
Elevate childhood cancer as a public health priority in national NCD strategies and pediatric health agendas.
Invest in cancer surveillance infrastructure, including population-based and hospital-based cancer registries.
Strengthen the pediatric oncology workforce through context-specific education and training.
Develop and implement evidence-based clinical guidelines adapted to local realities.
Ensure sustainable financing for childhood cancer programs, including through universal health coverage mechanisms.
Promote family- and community-centered care, including psychosocial support and palliative care from diagnosis onward.
The path toward reducing avoidable deaths from childhood cancer is complex, but the roadmap is clear. The CureAll Framework provides the structure; what remains is the political will, institutional commitment, and collective action to turn strategy into survival. By acting together—locally, regionally, and globally—we can transform the reality of childhood cancer care and give every child the chance to not only survive, but to thrive.
The studies compiled in this issue reaffirm the Journal of Human Growth and Development’s commitment to advancing interdisciplinary knowledge focused on human growth, development, and well-being across diverse life stages and contexts33. The articles span a broad scientific landscape, ranging from the economic potential of preconception care33 and the persistent burden of childhood morbidity and mortality due to diarrheal diseases in vulnerable populations34 to the clinical contributions of emerging technologies—such as transcranial direct current stimulation combined with virtual reality35 and CFTR modulator therapy for cystic fibrosis37.
Contemporary public health challenges also emerge, including gaps in breastfeeding knowledge among pregnant women36, the inappropriate use of anorexigenic and stimulant medications by adolescents39, and the adverse effects of sedentary behavior on the quality of life of patients undergoing hemodialysis40. Trends in COVID-19 among children41 and persistent inequities in sanitation42further illustrate the regional disparities that shape human development across Brazil41.
Finally, research on peripheral ischemia44 and vitamin D supplementation45broadens the spectrum of promising therapeutic approaches44, reinforcing the importance of innovative, evidence-informed strategies to promote health across all stages of life.
