of HIV care in the USA is $385,200 and undiscounted cost is $618,900 per person with a projected life expectancy of 24.2 years. Antiretroviral medications account for 73% of the costs, inpatient care 13%, 9% outpatient care, and 5% other HIV- associated drugs and laboratory costs. The investigators conclude that antiretroviral treatment has enhanced survival and have increased the lifetime cost of HIV medical care in the USA.
According to UNAIDS (2007), an estimated $10 billion is spent for HIV/AIDS prevention, care, and support in low- and middle-income countries. UNAIDS (2007) estimate that $42 billion in 2010 is needed to increase HIV/AIDS prevention, care, and support in these countries in order to achieve universal access. For fiscal year 2009, the US President’s budget request for HIV/AIDS funding for HIV/AIDs pre- vention, care, and research in low-and middle-income countries was $5.9 billion (Kaiser Family Foundation,2008).
Cancer and Leukemia
Nearly 30% of USA population is under the age of 20. In the USA in 2007, approx- imately 10,400 children under age 15 were diagnosed with cancer and about 1,545 children were died from the disease (American Cancer Society,2007).
Although this makes cancer the leading cause of death by disease among USA in children 1–14 years of age, cancer is still relatively rare in this age group. On average, one to two children develop the disease each year for every 10,000 children in the USA (Ries et al.,2004).
Over the past 20 years, the incidence of children diagnosed with all forms of invasive cancer has increased from 11.5 cases per 100,000 children in 1975 to 14.8 per 100,000 children in 2004. During this same time, however, death rates declined dramatically and 5-year survival rates increased for most childhood cancers. For example, the 5-year survival rates for all childhood cancers combined increased from 58.1% in 1975–1977 to 79.6% in 1996–2003 (Ries et al.,2004).
Lymphomas account for 10% of all childhood cancers (National Children’s Cancer Foundation,1997). Lymphoma, a cancer of the lymph nodes, has two types:
non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). NHL and HL are cancers that start in lymph tissues, such as the tonsils, lymph nodes, and thy- mus. These cancers may spread to bone marrow and other organs, which can cause different symptoms depending on where it is growing. They also can cause fever, sweats, weakness, and swollen lymph nodes in the neck, armpit, or groin.
NHL is most common in pre-adolescents and adolescents. The most com- mon symptoms of NHL are enlarged lymph nodes, difficulty breathing because of enlarged lymph nodes in the chest, an abdominal tumor from enlarged lymph nodes, fevers, weight loss, and lethargy. This cancer tends to metastasize to other areas rapidly, most commonly to the bones, CNS, and the bone marrow. Due to the link between the lymph node system and the immune system, Horowitz and Pizzo (1990) predict that the incidence of NHL may increase as the number of children with the AIDS virus increases.
HL “differs from NHL in that it usually demonstrates a slower onset and an orderly progression, involving contiguous lymph node areas” (Granowetter,1994).
The peak incidence of HL occurs in late adolescence, early adulthood, and middle age (Majhail et al.,2007).
Armstrong et al. (2010) evaluated late mortality among 5-year survivors of child- hood cancer and found that 30 years from diagnosis, the overall cumulative mortality was 18.1%.
Below is a discussion of different pediatric cancers:
Leukemia (30% of All Pediatric Cancers)
Childhood leukemias are cancers of the hematopoietic system. In a majority of cases, they produce a malignant change in lymphoid progenitor cells. Less com- monly, they cause changes in myeloid progenitor cells (Smith et al.,1996). About 3,250 children are diagnosed annually with leukemia. Two major types of leukemia are ALL and acute non-lymphocytic leukemia. One report found that ALL made up almost three-fourths of all leukemias, while the acute non-lymphocytic type com- prised 19% (Smith et al.,1996). The symptoms of leukemia may include bone and joint pain, weakness, bleeding, and fever (American Cancer Society,2007).
The incidence of ALL has varied with age. Smith et al. (1996) found a sharp peak in the incidence of ALL among young children, aged 2–3 years. The incidence was more than 80 per million for this age group. For children, aged 8–10 years, the rate decreases to 20 per million. The incidence of ALL is about 4 times greater than that for infants and is almost 10 times greater than that for 19-year-olds.
Racial differences have been shown in the incidence of leukemia. One report revealed that white children had a much higher incidence than African-American children for the period 1986–1995 (Smith et al.,1996). This investigation demon- strated that white children aged 0–14 years had a leukemia incidence rate of 45.6 per million compared to 27.8 per million for African-American children. This racial disparity is most evident when analyzing rates of leukemia by single year of age.
White children in the 2- to 3-year age group had a three times higher incidence compared to African-American children.
Brain and Other Nervous System (22.3%)
These cancers in their early stages may produce headaches, nausea, vomiting, blurred or double vision, dizziness, and problems in walking or handling objects.
Neuroblastoma (7.3%)
Neuroblastoma is a cancer of the sympathetic nervous system. Neuroblastoma can appear at any body site but usually develops as a swelling in the abdomen.
Cancer and Leukemia 21
Wilms’ tumor (5.6%)
Wilm’s tumor is a kidney tumor which causes a swelling or lump in the abdomen.
Non-Hodgkin Lymphoma (4.5%) and Hodgkin Lymphoma (3.5%)
NHL and HL have an impact on lymph nodes but may spread to bone marrow and other organs. They may produce swelling of lymph nodes in the neck, armpit, or groin and cause weakness and fever.
Rhabdomyosarcoma (3.1%)
Rhabdomyosarcoma, a soft-tissue sarcoma, develops in the head and neck, geni- tourinary area, trunk, and extremities, causing pain and/or a mass or swelling.
Retinoblastoma (2.8%)
Retinoblastoma is an eye tumor that usually afflicts children younger than 4 years of age.
Osteosarcoma (2.4%)
Osteosarcoma is a bone tumor. The disorder frequently does not cause any initial pain or symptoms until local swelling appears.
Ewing sarcoma (1.4%)
Ewing sarcoma is another cancer type that often develops in bone.
In 2007, about 1,545 deaths from pediatric cancer are expected to occur among children in the 0- to 14-year age group (American Cancer Society,2007). About one- third of these deaths are due to leukemia. Since 1975, the mortality rates for pediatric cancers have declined by 48%. New and improved treatments are responsible for these decreased mortality rates.
Relative survival varies by cancer type. For infants, relative survival is very good for patients with neuroblastoma, Wilms’ tumor, and retinoblastoma. Relative sur- vival is fairly good for leukemia patients. Children with ALL have experienced significant improvement in survival since the early 1970s and overall survival is now about 80% (Smith et al.,1996). Age at diagnosis affects survival rates for chil- dren with ALL. Children older than 1 year of age and less than 10 years of age have
the most favorable outcomes. Improvements in therapies have led to improved sur- vival in children with ALL. Children with other types of cancer do not have a fairly good survival rate.