A major global study in The Lancet finds childhood cancer survival has risen steadily over three decades.
It has surpassed 80% in many high‑income countries and put several nations on track to exceed the WHO’s 60% survival target by 2030.
Yet children in low‑ and lower‑middle‑income countries still face far lower survival.
This underlines deep gaps in diagnosis, treatment access and health‑system capacity.
Survival rates for children with cancer have improved worldwide over the past 30 years, but significant inequalities persist, according to a study published in The Lancet. Survival now exceeds 80 per cent in many high-income countries, but remains around 50-60 per cent in lower-middle-income countries.
Many countries are on track not only to achieve but also to surpass the World Health Organization’s 2018 Global Initiative for Childhood Cancer (GICC) target of 60 per cent five-year survival for all childhood cancers by 2030, the CONCORD-4 study, published on April 4, 2026, found.
However, this progress masks major data gaps and deep disparities in cancer care worldwide, with children in the poorest countries likely to face far lower survival rates.
The CONCORD Working Group, led by Claudia Allemani of the Cancer Survival Group at the London School of Hygiene & Tropical Medicine, developed a cancer survival index (CSI) using real-world data from 307 population-based cancer registries. The analysis covered 613,021 children with cancer in 68 countries over the period 1990–2019 and estimated changes in five-year survival by age, sex and country.
Trends in the five-year CSI for all childhood cancers combined showed consistent improvement in most countries. In Asia, several high-income countries maintained an upward trajectory. Japan’s five-year CSI rose from 66.2 per cent in 1990-94 to 85.9 per cent in 2015-19, approaching levels seen in North America and Europe. This improvement likely reflects long-standing government subsidies for cancer treatment for children and adolescents since the early 1970s.
Upward trends were also observed elsewhere in Asia. In Thailand, for example, the five-year CSI increased from 55.7 per cent in 2000-04 to 66 per cent in 2015-19, possibly due to universal health-care coverage and nationwide guidelines to improve access.
Progress was also recorded in North America, Oceania and parts of Europe, where the CSI rose from around 60 per cent in the 1990s to more than 80 per cent in 2015-19. These gains may partly reflect more consistent availability of anticancer medicines on the WHO Essential Medicines List for Children.
In contrast, late diagnosis, treatment abandonment and weak health systems continue to drive poor survival in low-income and lower-middle-income countries. Major inequities also exist in the oncology workforce: Low-income countries have as few as 0.09 oncologists per 100,000 population, compared with 1.6 per 100,000 in high-income countries. Access to radiotherapy shows similar disparities, ranging from 17 per cent in low-income countries and 73 per cent in middle-income countries to 93 per cent in high-income settings.
Assessments conducted in 2005-06 across ten low- and middle-income countries under the My Child Matters programme found access to care poor, deficient or inconsistent in seven countries. Five-year survival, estimated from interviews with health professionals, was as low as 5-10 per cent in five countries and 30-60 per cent in the remaining five. The authors noted that such surveys cannot substitute for national cancer registries.
Even in high-income regions, disparities persist. In Europe, variations in national formularies and procurement policies can reduce medicine availability. Moreover, the CSI can only be constructed where population-based registries exist and share data. Legal or administrative issues prevented 46 of 371 operational registries from participating in CONCORD-4.
In sub-Saharan Africa, urgent action is needed to address a growing cancer burden. Without rapid interventions, cancer mortality is projected to rise from 520,348 deaths in 2020 to about one million annually by 2030. Yet the region still lacks adequate population-based cancer registry coverage.
Participation in CONCORD-4 was further limited when the African Cancer Registry Network allowed only previously published data based on small samples to be shared, leaving major gaps in comparable monitoring of progress towards the GICC target.
Childhood cancer remains the eighth leading cause of death among children worldwide. Global Burden of Disease estimates published in The Lancet suggest 377,000 children aged 0-19 developed cancer in 2023. Around 85 per cent of cases and 94 per cent of deaths occurred in low- and middle-income countries.
The WHO Western Pacific and African regions recorded the highest numbers of cases in 2023, while the African region had the most deaths, which increased by nearly 56 per cent between 1990 and 2023. In India, childhood cancer was among the top ten causes of death in children, accounting for 17,000 deaths in 2023.
“The vast majority of children with cancer live in low- and middle-income countries, where delays in diagnosis, lack of access to essential cancer treatment, and other health system limitations and barriers to care can contribute to disparities in childhood cancer burden,” said Lisa Force, lead author from the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine.
The researchers said the findings highlight the importance of population-based cancer registries in providing real-world evidence of progress in childhood cancer control and emphasise the need to protect and expand cancer registration systems as the foundation of effective cancer care.