Establishing a pediatric radiation oncology department in a low‐ and middle‐income country: Major challenge in implementing the Global Initiative for Childhood Cancer

Childhood cancer is becoming a major challenge with the gradual decrease in mortality from communicable diseases in lowandmiddleincome countries (LMICs).1–3 As estimated, 80% of pediatric cancer occurs in LMICs.4,5 However, there is a stark contrast between survival rates in high-income countries (HICs) and LMICs, with an estimated gap of 50%–60%.6,7 Many children in LMICs do not benefit from medical and technical advances available in HICs.8 Diagnosis is often delayed owing to shortage of appropriate diagnostic facilities and specialized pediatric cancer centers.9,10 Compounding the situation are health care-related costs, low educational level of parents, lack of public awareness, and treatment abandonment.11 Moreover, due to inadequate nationwide cancer registries in most LMICs, underdiagnosis and underreporting of childhood cancers reduce allocation of funds for pediatric oncology in nations with already limited financial resources.6 In September 2018, the World Health Organization (WHO) launched the Global Initiative for Childhood Cancer (GICC), in which both St. Jude Global and the International Society of Pediatric Oncol-

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