PURPOSECancer imposes substantial economic burden through indirect costs associated with labor outcomes and productivity loss. This systematic review and meta-analysis quantifies labor and productivity outcomes among patients with cancer and survivors to inform economic evaluations and policy development.METHODSWe systematically searched PubMed, EconLit, and Web of Science databases in June 2025 using cancer, productivity loss, and labor outcomes terminology. Peer-reviewed studies reporting eight outcomes were included. Following screening of 6,239 abstracts and full-text review of 358 articles, 144 studies from 27 countries met inclusion criteria for meta-analysis.RESULTSThe available evidence skews strongly toward formal employment situations in high-income, Western countries. We estimate a 25% productivity loss due to absenteeism (95% CI, 18 to 32) and a 23% productivity loss due to presenteeism (95% CI, 21 to 26); working hours are reduced by 19% (95% CI, 14 to 24); the return-to-work rate is 47% (95% CI, 39 to 54) with a median time of 239 days for full return; the overall job loss rate is 9% (95% CI, 8 to 11; 35% for advanced cancer; 95% CI, 22 to 48); the unemployment rate is 29% (95% CI, 22 to 36); the long-term disability/pension use is 11% (95% CI, 0 to 22); and the early retirement rate is 14% (95% CI, 8 to 20). For each reported outcome, cancer's productivity costs are observed to be more severe among women than men.CONCLUSIONThis represents the largest comprehensive meta-analysis of cancer-related labor outcomes to date. Estimated labor and productivity consequences are in line with previous research, but outcomes varied significantly by gender, cancer stage, geographic region, and time since diagnosis. Subgroup analysis provides nuanced insight into how these factors influence labor and productivity outcomes. These evidence-based estimates provide critical inputs for economic evaluations and support development of policies to maintain professional productivity among patients with cancer and survivors.

Cancer remains a leading cause of morbidity globally, largely attributable to modifiable risks. We estimated the 2022 global and national cancer burden attributable to 30 such factors, including tobacco smoking, alcohol consumption, high body mass index, insufficient physical activity, smokeless tobacco and areca nut, suboptimal breastfeeding, air pollution, ultraviolet radiation, 9 infectious agents and 13 occupational exposures, to inform prevention efforts. Using GLOBOCAN data for 36 cancer sites in 185 countries, we applied prevalence data from around 2012 to reflect exposure-cancer latency and estimated Levin-based or Miettinen-based population-attributable fractions (PAFs) or direct estimates where applicable. Combined PAFs accounting for overlapping exposures were derived by cancer, sex, country and region. In 2022, an estimated 7.1 million of 18.7 million new cancer cases (37.8%) were attributable to 30 modifiable risk factors-2.7 million (29.7%) in women and 4.3 million (45.4%) in men. The proportion of preventable cancers ranged from 24.6% to 38.2% in women and from 28.1% to 57.2% in men across regions. Smoking (15.1%), infections (10.2%) and alcohol consumption (3.2%) were the leading contributors to cancer burden. Lung, stomach and cervical cancers represented nearly half of preventable cancers. Strengthening efforts to reduce modifiable exposures remains central to global cancer prevention.

Background Bereavement following a cancer-related death profoundly affects families, yet global evidence on grief and its relationship with end-of-life care experiences remains limited. This WHO-supported study examined emotional challenges, grief symptoms, and perceptions of care among bereaved family members across high-, middle-, and low-income countries. Methods The WHO Lived Experience of Cancer survey was disseminated in 120 countries in 25 languages(1). Participants answered questions about their bereavement experiences, access to palliative care services and advance-care planning, and emotional challenges such as depression, anxiety, adjustment difficulties since the death (‘yes’/’‘no’). Probable Prolonged Grief Disorder (PPGD) was identified according to the PG-13-R scoring guidelines, requiring endorsement of core symptoms, functional impairment, and bereavement duration >12 months. Open-ended responses explored participants’ greatest emotional challenges since the death. Results 316 participants answered questions about their bereavement experiences (86% female; 74% in high-income countries; 34% were parents whose child died from cancer). The most prevalent self-reported emotional challenges were adjustment difficulties (59%), depression (55%), and post-traumatic stress symptoms (38%). Among the 108 participants who provided complete PG-13-R data, the mean score was 33.7 (SD:10.8; bereaved parents: 35.1; others: 32.5), and 37% met criteria for PPGD. Qualitative responses revealed recurring themes of enduring loneliness, guilt, anger, and identity disruption. Participants from LMICs shared distress over resource shortages and the emotional toll of witnessing preventable suffering. Bereaved parents highlighted experiences of emotional isolation, difficulty communicating their grief with others, and the challenge of sustaining hope while caring for their surviving children. Conclusions Participants reported enduring emotional distress following family members’ cancer-related deaths. Reported PG-13-R scores and PPGD rate appear higher than those typically reported in cancer-bereaved populations, although these findings may reflect our non-representative sample and incomplete data. Strengthening equitable access to palliative and bereavement-informed care is vital in promoting long-term family wellbeing and quality of life.

ABSTRACT Introduction Lifelong follow‐up care for childhood cancer survivors (CCS) is recommended and ideally involves both medical and psychosocial care. It is important for CCS and their families to be adequately informed about what to expect after cancer treatment completion to ensure they receive appropriate care. This study aimed to describe patterns of access to survivorship care among a multi‐national sample, as well as examine unmet information and support needs, for CCS and their parents. Method An online survey, developed by pediatric psycho‐oncology experts and people with lived experience of pediatric cancer, was distributed by the World Health Organization. This study presents a subanalysis from these data. Results Participants included 102 parents of CCS (94 females, mean age 45 years, mean time since child's diagnosis 9 years), and 43 CCS (28 females, mean age 31 years, mean time since diagnosis 21 years) from 17 countries. Thirty‐five percent of CCS (13/37) were not accessing survivorship care. Most parents (95%; 97/102) and CCS (76%; 31/41) reported a desire for discussion of emotional impacts following cancer treatment completion; however, this did not occur for 69% (70/102) of parents and 46% (19/41) of CCS. Additionally, 92% (93/102) of parents and 83% (33/41) of CCS reported an unmet need for more information about what to expect after cancer treatment. Most CCS (54%; 22/41) reported feeling “somewhat—not at all” supported by healthcare professionals in the period after cancer treatment. Conclusion Discussions regarding emotional well‐being and ongoing needs post treatment are lacking in cancer survivorship care worldwide.

BACKGROUND:Although childhood cancer survival outcomes have markedly improved over the past several decades due to therapeutic advancements, significant gaps remain in accessibility to cancer medicines for children. We aimed to analyse the global paediatric oncology landscape and pipeline of all childhood cancer medicines that are in common use or development. METHODS:We searched the International Clinical Trials Registry Platform (ICTRP) for paediatric oncology trials registered between Jan 1, 2007 and Aug 2, 2022, to identify childhood cancer medicines. From each trial's full entry and further online search across various sources, we obtained information on mechanism of action, molecular target, most recent development phase, malignancy inclusion in trials, administration route, paediatric-friendly oral formulation availability, storage requirements, and regulatory approval status for each cancer medicine. Cellular therapies were analysed separately by target, most recent development phase, malignancy inclusion in trials, and regulatory approval status. We summarise attributes of childhood cancer medicines and paediatric oncology trial conduct. FINDINGS:Of 5068 clinical trials downloaded from the ICTRP, 2160 met inclusion criteria for full review and data extraction. The highest clinical trial participation was in high-income countries, the majority being in the Americas (1006 trials), the Western Pacific (843 trials), and Europe (588 trials). We identified 440 unique childhood cancer medicines, excluding cellular therapy; of these, 243 (55%) medicines were either molecular targeted therapies or immunotherapies. Of 212 medicines with available information, 79 (37%) required cold storage, and 112 (55%) of 204 required light protection. Paediatric-friendly formulations were available for 57 (45%) of 126 orally administered medicines. Of the 440 cancer medicines used in paediatric cancer trials, 37 (8%) and 85 (19%) are approved for children by the European Medicines Agency (EMA) and US Food and Drug Administration (FDA), respectively, with a median approval lag time between adult and paediatric approvals of 2 years (IQR 0-7) for the EMA and 3 years (0-10) for the FDA. 274 (62%) of 440 cancer medicines were in phase 1 or 2 of development. Most cellular therapies in clinical trials were chimeric antigen receptor (CAR) T-cell therapies, targeting 48 unique antigens. INTERPRETATION:This overview of the global paediatric oncology landscape and pipeline of childhood cancer medicines highlights important barriers to improving effective treatment access for all children. Further analyses of these data, which are now publicly available on an online dashboard hosted by the WHO Global Observatory on Health Research and Development, should guide stakeholders in further investigation of clinical trial results to inform drug prioritisation for clinical development, paediatric-friendly formulations, expedited regulatory approvals, essential medicine designation, and local capacity building. FUNDING:St Jude Children's Research Hospital.

Background:Survival rates for childhood cancer reveal stark global disparities. While over 80 % of children survive in high-income countries (HICs), outcomes remain significantly lower in low- and middle-income countries (LMICs), where the burden is also higher. This study synthesizes observational data on survival outcomes for the six WHO Global Initiative for Childhood Cancer (GICC) index cancers in LMICs, aiming to establish survival estimates, identify key determinants, and assess data limitations. Methods:Following JBI and PRISMA-ScR guidelines, we conducted a scoping review searching MEDLINE, WHO Global Index Medicus, and EMBASE for observational studies published since 2013. Studies included children aged 0-19 diagnosed with acute lymphoblastic leukemia, Burkitt lymphoma, Hodgkin lymphoma, low-grade glioma, retinoblastoma, or Wilms tumor in LMICs. Results:From 6358 records, 196 studies were included. Most (72.9 %) were retrospective cohorts; 71.9 % were single-institution studies. The most frequently reported cancers were acute lymphoblastic leukemia (35.2 %) and Wilms tumor (29.1 %). Mean reported overall survival varied widely, from 62.5 % for Burkitt lymphoma (range 20.0-92.0 %) to 78.6 % for Hodgkin lymphoma (range 40.0-96.6 %). Median follow-up was often poorly reported. Socioeconomic barriers, limited healthcare access, and diagnostic delays were common determinants of poor outcomes. Only 10 % of studies referenced hospital-based registries, and fewer than 5 % used population-based data, highlighting critical data gaps. Conclusions:This review underscores emerging evidence and persistent limitations in childhood cancer survival data from LMICs. The predominance of single-center, retrospective studies indicates a need for more standardized, collaborative research.

Background Non-communicable diseases (NCDs) account for over 60% of annual global deaths, disproportionately affecting low- and middle-income countries. This trend undermines progress toward Sustainable Development Goal (SDG) 3.4, which seeks to reduce premature mortality from NCDs by one-third by 2030. Despite the availability of effective and relatively affordable interventions, addressing NCDs requires sustained, coordinated efforts and robust monitoring systems. Facility-based monitoring offers a dynamic alternative to static surveys, enabling continuous assessment of healthcare quality and utilization. Methods This study followed a systematic approach to develop standardized global and national NCD monitoring indicators, using the Donabedian model as a conceptual framework. It focused on four major NCD categories: hypertension and cardiovascular diseases (CVDs), diabetes, chronic respiratory diseases, and cancers. The methodology included systematic scoping reviews from inception up to November 2021 and a multi-round Delphi process involving global experts to assess the validity and feasibility of proposed indicators. This study was funded internally by WHO. There were no payments to participants. Findings The final output consisted of 81 validated indicators—22 core and 59 optional. These indicators demonstrated high feasibility and relevance for facility-based monitoring of NCD service delivery. They provide actionable metrics for assessing and improving the quality of care across diverse health system settings. Interpretation This study highlights the urgent need for comprehensive, context-sensitive NCD monitoring frameworks. The proposed set of indicators offers a validated foundation for improving NCD care delivery and aligns with efforts to achieve SDG target 3.4. Ongoing updates and local adaptations will be essential to ensure continued relevance and effectiveness. Funding This study was funded internally by WHO.

The coronavirus disease 2019 pandemic substantially impacted the delivery of cancer services and programs. Here we reviewed and synthesized the global scale and impact of pandemic-related delays and disruptions on cancer services, including diagnosis, diagnostic procedures, screening, treatment and supportive and palliative care. Based on data from 245 articles in 46 countries, we observed declines in the number of cancer screening participation (39.0%), diagnoses (23.0%), diagnostic procedures (24.0%) and treatment (28.0%), ranging from a 15.0% decline for radiotherapy to a 35.0% decline for systemic treatment during the pandemic compared to during the prepandemic period. Medium-human development index (HDI) category countries experienced greater reductions than high- and very-high-HDI countries. Missing data from low-HDI countries emphasize the need for increased investments in cancer surveillance and research in these settings. PROSPERO registration: CRD42022301816.

Background:Access to immune checkpoint inhibitors remains limited due to cost-effectiveness and affordability concerns. This study evaluates the financial impacts of expanding global access to PD1/PD-L1 inhibitors as first-line monotherapy for patients aged 40-74 years with advanced unresectable non-small cell lung cancer (NSCLC), with wildtype EGFR and ≥50% of tumour cells with PD-L1 expression. Methods:The potential usage and associated costs were assessed from 2024 to 2040 through repeated cross-sectional assessments. The base case assumed treatment rates in countries with access to PD1/PD-L1 inhibitors in 2023, while expanded-access scenarios projected coverage increases to 30% in low-income, 50% in lower-middle-income, 80% in upper-middle-income (UMICs), and 95% in high-income countries over 10 years. Findings:The model estimated that 200,000-250,000 individuals are treatment-eligible, with only about one-fifth receiving PD1/PD-L1 inhibitors in the base case. Expanding access would increase global treatment coverage to 75% by 2040, particularly in middle-income countries. The largest increases would be in UMICs (+100,700) and the Western Pacific region (+82,400). At an estimated per-patient lifetime cost of US$37,600-US$75,100, total costs could reach US$14,087 million with fixed dosing, or US$9080 million with weight-based dosing. PD-L1 testing costs would add <1% to the total. Interpretation:Expanding access to PD1/PD-L1 inhibitors for advanced NSCLC over 10 years demands significant funding, making equitable access in lower-income countries doubtful without a significant price reduction. Policymakers should negotiate lower prices to ensure cost-effectiveness and affordability, improve spending efficiency by optimised dosing and treatment duration, and enhance health system capacity, including ensuring appropriate use and introducing biosimilars. Funding:This publication was made available as open access through WHO funding provided by two projects: the Universal Health Coverage Partnership (Award 74812, the European Union, the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, the United Kingdom's Foreign, Commonwealth & Development Office, the Government of Belgium, the Government of Canada, and the Government of Germany) and the Increasing Global Equitable Access to Health Products & Health Technologies project (Award 72913, the Government of Belgium).

Cancer remains a leading cause of morbidity globally, largely driven by modifiable risk factors. We provide estimates of the global and national cancer burden attributable to these factors, namely tobacco smoking, alcohol consumption, high body mass index (BMI), insufficient physical activity, smokeless tobacco and areca nut, suboptimal breastfeeding, air pollution, ultraviolet radiation (UVR), infections (due to nine agents), and occupational (due to 13 agents) exposures to inform prevention efforts. We estimated 2022 cancer cases attributable to 30 modifiable risk factors in 185 countries using GLOBOCAN data for 36 cancer sites. Risk factors were grouped as behavioural, environmental, infectious, or occupational, with prevalence data from around 2012 to reflect latency between exposure and cancer diagnosis. Population-attributable fractions (PAFs) were estimated using the Levin or Miettinen formulas, or derived directly from prevalence data where applicable, and adjusted for cancer subtypes when relevant. Combined PAFs accounting for overlapping exposures were derived by cancer, sex, country, and region. In 2022, an estimated 7.1 million of 18.7 million new cancer cases (37.8%) worldwide were attributable to 30 modifiable risk factors – 2.7 million (29.7%) in women and 4.3 million (45.4%) in men. The proportion of preventable cancers varied across regions and by sex, ranging from 24.6% of all new cancer cases in Northern Africa and Western Asia to 38.2% in sub-Saharan Africa for women and from 28.1% in Latin America & the Caribbean to 57.2% in East Asia for men. Smoking, infections, and alcohol consumption were the leading contributors to cancer burden globally, accounting for 15.1%, 10.2%, and 3.2% of all new cancer cases, respectively. Lung, stomach, and cervical cancers showed the greatest potential for prevention, together representing nearly half of all preventable cancers. Reducing exposure to modifiable risk factors offers major opportunities for cancer prevention worldwide, underscoring the importance of tailored, evidence-based and gender-sensitive strategies across populations.

BACKGROUND:Cancer is among the most important causes of premature deaths globally. We estimated the value of paid and unpaid productivity losses due to premature mortality in 2022 from all cancers worldwide. METHODS:Years of productive life lost were derived from cancer mortality data for 36 cancer types among people of working age (15-64 years) in 185 countries for the year 2022. Paid productivity losses were estimated using the human capital approach, while unpaid activities were valued using the opportunity cost approach. Lost productivity was estimated using wages, workforce statistics, and time spent on unpaid activities from various sources. All analyses were performed by sex and age group for each country. RESULTS:In 2022, productivity losses from premature cancer mortality were valued at an estimated US$566 billion, equivalent to 0.6% of the global gross domestic product. Of the total value, 53.9% (US$305 billion) was attributable to paid productivity losses, and 46.1% (US$260 billion) to unpaid productivity losses. Paid productivity losses were generally higher among men, while unpaid productivity losses were greater among women, with variations seen across world regions. The total value of lost productivity was greatest for lung cancer, followed by breast and liver cancers. Per cancer death, testicular cancer, melanoma of the skin, and brain and nervous system cancer generated the highest value of productivity losses. CONCLUSION:The substantial value of productivity losses from premature cancer mortality highlights its marked societal burden. Continuous investments in global cancer control efforts, including in less common cancers, will yield substantial returns-on-investment to national economies, especially in transitioning countries.

Clinical trials are essential to advancing cancer control, yet access and participation remain unequal globally. The World Health Organization (WHO) established the International Clinical Trials Registry Platform (ICTRP) to enable a complete view of interventional clinical research for all those involved in healthcare decision-making and to identify actionable goals to equitable participation at the global level. A review of 89,069 global cancer clinical trials registered in the WHO ICTRP between 1999 and December 2022 revealed a cancer clinical trial landscape dominated by high-income countries and focused on pharmacological interventions, with multinational collaboration limited to only 3% of recruiting trials. Several of the deadliest cancers, including liver, stomach, pancreas and cervical cancer, were consistently missing from the top most-studied cancer types, particularly in Africa and Southeast Asia. In this Review, we summarize the key findings of the WHO global landscape review and discuss strategies to act on these data, which provide critical empirical evidence to inform policy, practice and investment decisions.

Assessing differences between lived experiences of people affected by cancer internationally facilitates direction of international health policies and standards. The study piloted, on behalf of the World Health Organization (WHO), a global survey assessing the lived experience of people affected by cancer. We aimed to determine (1) the acceptability of the survey and (2) the survey’s capacity to capture a globally representative sample of people diagnosed with cancer. The cross-sectional survey went through two pilot rounds. We (1) solicited feedback from international cancer organisations through a feedback form, and (2) launched a global online survey, requesting open-ended feedback on the survey format/content from people diagnosed with cancer, their family members/caregivers, and bereaved family members. Round one: 23 stakeholders found the survey acceptable in length/content. Minor suggestions were to improve readability/applicability across healthcare settings. Round two: 505 individuals participated: 177 (35

PURPOSEOvarian cancer remains among the most aggressive tumors with the lowest survival probability. Projections are that ovarian cancer will claim more than 8 million lives between 2022 and 2050 without better prevention or control measures.METHODSWe built an Excel-based instrument that uses a prevalence-based cost-of-illness approach and a societal perspective to estimate the burden of ovarian cancer. The instrument leverages data from editions of the World Ovarian Cancer Coalition's Every Woman Study, contains a micro-costing framework to assess the resources and costs of providing care, and uses data from novel systematic reviews and meta-analyses conducted to estimate the effect of ovarian cancer on patient labor productivity outcomes and the time caregivers devote to caring for people living with the disease.RESULTSAcross 11 countries, we estimated US dollars 70 billion in socioeconomic losses attributable to ovarian cancer. Health expenditures to cover treatment in the first 2 years after diagnosis were 7, 41, and 118 times total health spending per capita in high-, upper-middle-, and low- and lower-middle countries, respectively. Patients spent 3,663 years traveling to or receiving treatment. Women lost labor productivity equivalent to 2.5 million workdays due to ill-health from ovarian cancer, and 9,403 women living with ovarian cancer or survivors were estimated to be missing from the workforce. Caregivers spent 17,112 person-years providing practical support to patients—an average of 33 days per woman living with ovarian cancer.CONCLUSIONThis study is the first to quantify the social and economic burden of ovarian cancer in 11 countries and highlights its significant cost and defines actions needed to improve ovarian cancer outcomes.

Background:Cancer is the third leading cause of death in Kenya. Breast cancer is responsible for 3100 deaths annually. Quantifying the economic and social impacts of breast cancer supports inclusion of cancer care within Kenya's universal healthcare plan. Methods:Kenya's Ministry of Health led an economic cost-benefit analysis of expanding breast cancer prevention and treatment services. Three scenarios (early diagnosis only, screening with clinical breast exam (CBE-led), and screening with mammography (MG-led)) were modelled using an adapted version of a deterministic state-transition cohort simulation model jointly developed by the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) and maintained by Forecast Health. Real world evidence on the favorable stage-shift induced by each early detection scenario was used as model inputs. The model estimated the mortality benefits of favorable stage-shifting, and net financial costs and health and economic benefits in 2020 USD. Findings:Respectively, over 40 years, the cost to sustain early diagnosis programs only, CBE-led screening, or mammogram-led screening would require 1.4, 2.8, or 5.2 percent increases above current government health spending. All three strategies are economically efficient in the long run. Net economic benefits of expanded breast cancer care using clinical breast exam screening are $2.3 billion dollars (USD) over the next 40 years with 236,000 women's lives saved in Kenya. Mammographic screening provides net benefits of $1.9 billion (USD) with an additional 34,000 lives saved over 40 years compared to the CBE-led screening approach. Over 40 years, an early diagnosis-only strategy saves the fewest lives and has the lowest net benefit among the three strategies. Interpretation:We offer a novel economic evaluation for breast cancer prevention and care expansion within Universal Health Coverage in Kenya. It demonstrates the economic viability of providing those services in a low-middle income (LMI) context. Funding:The work was funded by the World Bank Group's Tackling Non-Communicable Diseases Challenges in Low- and Middle-Income Countries Trust Fund, supported by the Access Accelerated Partnership. This report was also partially financed by the Global Financing Facility for Women, Children and Adolescents (GFF). The GFF is a global multi-stakeholder partnership hosted at the World Bank that provides catalytic financing and technical support for safe and equitable delivery of essential health and nutrition services for women, children and adolescents, while helping countries to build more resilient health systems.