Childhood Cancer Survival Outcomes in India: A Scoping Review of Three Decades of Survival Data for Policy Insights.
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PURPOSE: Childhood cancer is an under-recognized public health priority in low- and middle-income countries. India bears a substantial share of the global burden, yet survival outcomes are poorly documented. This scoping review synthesizes survival outcomes across childhood cancers in India, assesses geographic disparities, and benchmarks against international standards to inform national policy and system strengthening. METHODS: We searched PubMed, Scopus, Web of Science, and Embase (January 1994 to December 2023) for studies reporting survival outcomes among childhood cancers (0-18 years) in India. Two reviewers independently screened records, extracted data, and conducted descriptive synthesis by cancer type excluding case reports and registry summaries. Exploratory forest plots were created where ≥3 studies reported comparable end points. The protocol was prospectively registered on Open Science Framework. RESULTS: Of 6,505 records screened, 182 studies (22,886 children) were included. Most were retrospective (78%) and single-center (94%), concentrated in four tertiary hospitals. Exploratory pooled estimates derived from descriptive analyses showed that the 5-year overall (OS) and event-free survival were 67.1% (95% CI, 56.9 to 77.2) and 59.2% (95% CI, 48.0 to 70.3) for ALL and 93.1% (95% CI, 91.7 to 94.4) and 85.3% (95% CI, 81.3 to 89.3) for Hodgkin lymphoma (HL). The pooled median OS for AML and Ewing sarcoma was 25.4 months (95% CI, 16.8 to 33.9) and 21.2 months (95% CI, 14.6 to 27.7), respectively, whereas the 3-year OS for neuroblastoma was 56.9% (95% CI, 45.7 to 68.0). Reporting was inconsistent, with frequent omission of CIs and heterogeneity across regions. CONCLUSION: Childhood cancer survival in India remains variable, with HL nearing global benchmarks, but leukemias and solid tumors show inferior outcomes. Strengthening national cancer registries, research infrastructure, and political commitment is critical for achieving equity in childhood cancer care.