Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Nursing Science

Research Advisor

Scott C. Howard


Xueyuan Cao Donna K. Hathaway Belinda N. Mandrell Mona N. Wicks


Chemotherapy, Forecasting, Incidence, Income, LMIC, Multipliers


Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, with contemporary therapy resulting in a 90% survival in high-income countries (HIC). However, an estimated 89% of the world’s children live in low- and middle-income countries (LMIC) where survival is much lower. Lack of access to essential chemotherapy contributes significantly to the decreased survival rates for LMIC, and inaccurate forecasting of chemotherapy needed may lead to stockouts or oversupply. This chapter describes a simple forecasting system with population and patient-based multipliers for each drug used in the treatment of pediatric ALL, thus estimating the essential chemotherapy quantities needed for a single patient, facility, region, or country.

We described a forecasting model for estimating essential chemotherapy in the treatment of childhood ALL to multipliers. Multipliers were obtained from a reference population of 10 million children evenly distributed (2.5 million each) across four age cohorts at 5-year intervals (0-4, 5-9, 10-14, and 15-19 years). The forecasting model and multipliers were applied to 171 countries with age-specific population data available in the United Nations 2017 World Populations Prospects. Results from the forecasting model and multipliers were compared to determine differences for each country and for countries with extreme population distributions across the pediatric age range. The multipliers produced results no greater than 15% of those obtained using the forecasting model.

Multipliers allow healthcare providers, cancer centers, hospitals, countries, and drug manufacturers to accurately estimate the essential chemotherapy needs for a patient, facility, region, or country. This practical tool can be applied to other cancer diagnoses and treatment protocols.

Declaration of Authorship

Declaration of Authorship is included in the supplemental files.