Cancer is the second leading cause of death worldwide, accounting for nearly 10 million deaths in 2020. This mortality burden has immense personal, family, and societal impacts, resulting in more than 170 million years of life lost and huge economic costs to patients and health systems. Less often considered is the impact of cancer in adults on their children, which may extend across the phases of cancer care and, for adults who do not survive, beyond the parental death. A recent breast cancer cohort study in Africa – the African Breast Cancer - Disparities in Outcomes (ABC-DO) Study – found that across five sub-Saharan African countries the number of children left motherless due to breast cancer deaths exceeded the number of breast cancer deaths.
A motherless child younger than 18 years is a maternal orphan, per the UNICEF definition. About 71% of cancer deaths globally occur at age 60 years or older, when most children of deceased parents would already be adults. However, in populations with young demographics, the average age at cancer diagnosis and at cancer death is younger, when children of deceased parents may still be young. Lower-income countries have younger population structures and are often characterized by relatively low cancer survival; thus, when an adult dies from cancer, their death is more likely to result in cancer orphans. Despite this, there are no global estimates of the number of cancer orphans.
This project aims to estimate the number of maternal orphans due to cancer deaths globally in 2020 and describe its distribution by country and cancer type.
This project will provide the first global estimates of the number of maternal cancer orphans. The focus is on maternal orphans, rather than paternal orphans or any orphans, for several reasons. First, among cancer deaths before age 50 years, women are disproportionately affected compared with men, and especially so in low-income countries, because of low survival from common female-dominant or female-specific cancers: breast cancer and cervical cancer. Second, the higher fertility of women in lower-income countries is also characterized by long reproductive lives, including a late maternal age at last birth, i.e. births of children who may still be younger than 18 years if and when their mother dies. The third reason is methodological, because more data are available from fertility surveys on the children of women than of men.
The consequences of orphanhood can have long-term negative impacts on a child’s life across multiple dimensions. Orphan children have higher risks of experiencing mental health problems, physical, emotional, and sexual violence, lower educational attainment, and family poverty. Orphans are also more likely to drop out of school and to become entangled in a cycle of poverty. One study found that their risk of suicide was twice that of peers who hadn’t experienced the death of a parent; the risk remained elevated for 25 years after such a death. In adolescents, the risks of pregnancy, infectious diseases including HIV/AIDS, and chronic diseases are also higher in orphans than in their peers.
The objective of this project is to estimate the global number of orphans due to maternal deaths from cancer in 2020. In addition, the number of orphans by country and cancer type will be described and explored to determine the main cancer types contributing to these numbers and the regional disparities.