A nationwide cohort study examining five-year cancer survival and access to health care among children and adolescents in China was published in The Lancet in December 2025. Drawing on nationally representative data, the study offers the most comprehensive real-world assessment of childhood and adolescent cancer outcomes in China to date.

The research was conducted through the National Center for Pediatric Cancer Surveillance by a pediatric oncology research team led by Prof. Ni Xin at Beijing Children’s Hospital, Capital Medical University (National Center for Children’s Health). The surveillance system supporting the study was established with the approval of the National Health Commission of China.

The findings offer robust evidence on survival outcomes and socioeconomic inequalities in pediatric cancer care, with implications for health-system planning in China and for global childhood cancer control.

Study Design and Data Source

The analysis included 95,189 cancer cases diagnosed between 2018 and 2020 among children and adolescents aged 0–19 years. Eligible cases comprised all cancers, non-malignant tumors of the central nervous system and reproductive system, and tumors of uncertain or unknown behavior.

Five-year survival was estimated across strata defined by age, sex, cancer type (International Classification of Childhood Cancer, third edition), regional Socio-demographic Index (SDI), and treatment location (within or outside the patient’s home province).

Survival Outcomes

The overall five-year observed survival was 77.2%. Survival was 77.8% among children aged 0–14 years and 75.3% among adolescents aged 15–19 years, with higher survival among girls (79.0%) than boys (75.8%).

Among 12 main cancer groups, retinoblastoma had the highest five-year survival (91.2%), while malignant bone tumors had the lowest (60.4%).

Five-year survival for all six cancers prioritized under the WHO Global Initiative for Childhood Cancer exceeded 80%, reaching up to 93.8%, surpassing the WHO target of 60%. Survival outcomes for several common pediatric cancers are now approaching levels reported in high-income countries.

These improvements are associated with sustained health-system developments in China, including expanded medical insurance coverage, improved interprovincial reimbursement mechanisms, targeted programs for major childhood diseases, increasing adoption of standardized treatment protocols, and the growth of multicenter collaborative networks.

Regional Disparities and Access to Care

Survival varied substantially by region, ranging from 72.6% in low-SDI regions to 84.9% in high-SDI regions. Disparities were more pronounced among adolescents.

Nationwide, 23.5% of patients received their initial diagnosis and treatment outside their home province. Interprovincial care was associated with lower mortality risk overall, but survival differences of up to 18.2 percentage points were observed across socioeconomic strata. 58.8% of interprovincial patients sought care in higher-SDI regions, reflecting structural imbalances in pediatric oncology resources.

Research-Based Implications

Using scenario-based analyses, the study identified priorities for a more stratified allocation of pediatric cancer care resources. The findings suggest that in lower-resource regions, investments in foundational diagnostic capacities—such as pathology services—were associated with substantial potential survival gains, while in more developed regions, strengthening comprehensive treatment systems and continuity of care is likely to be more impactful. Collectively, these results provide an evidence base to support more cost-efficient and equitable national planning of pediatric cancer care resources.

Building on these findings, the study highlights the importance of coordinated, system-level approaches to address persistent disparities in access to pediatric cancer care, particularly in the context of widespread interprovincial health care seeking.

Key considerations include more balanced resource allocation, reduced financial burden on families, strengthened insurance and social support systems, development of regional pediatric cancer centers, standardized tiered referral pathways, expanded use of AI-assisted diagnostic tools in resource-limited settings, and improved continuity of care for adolescents transitioning to adult services.

Global Relevance

Taken together, the findings highlight both the progress achieved and the remaining challenges in pediatric cancer care in China. They also offer evidence relevant to other countries seeking to strengthen childhood cancer control through national surveillance, standardized care, and health-system coordination, particularly in resource-diverse settings.

Reference

Ni X, Li Z, Liu Y, et al. Socioeconomic inequalities in cancer survival and access to health care among children and adolescents in China, 2018-24: a prospective nationwide cohort study. Lancet. 2026;407(10525):237-255. doi:10.1016/S0140-6736(25)01911-7