Background
Orphans, i.e. children (<18 years) who have lost either or both of their parents, often face numerous health, support and educational disadvantages throughout life. We showed that, in 2020, more than 1 million children lost their mother to cancer worldwide (Guida et al, 2022, Nat Med). To complete this picture, we will present the first global estimates of paternal orphans due to cancer.
 
Objectives
This study aims to estimate the global number of new paternal orphans due to male deaths from cancer in 2020.
 
Methods
We estimated the number of new paternal orphans due to cancer by combining country- and age-specific male fertility rates with country- and age-specific number of deaths in women in 2020 (GLOBOCAN), while considering country-specific mortality rates experienced by the children (UN World Population Prospects). As fertility rates in men were not immediately available, we used different sources of data to estimate them: civil registrations and vital statistics systems, Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and censuses. We scaled these estimated fertility age-patterns to lead to the same number of births as for the females.  
 
Results
In 2020, 5.5 million men died from cancer worldwide. We estimated that these deaths led to 1.41 million new paternal orphans, among which 72% were due to paternal deaths occurring above 45 years old. Most orphans occurred in Asia (52%) and Africa (31%) and were due to deaths from gastrointestinal cancers (38 %), of which the majority were liver cancer (14%), followed by lung and trachea cancers (13%) and head and neck cancers (12%). Children were 12 years old on average at paternal death. A strong inverse correlation was present between Human Development Index (HDI) and number of new paternal orphans per 100 male cancer deaths but no clear association with HDI level was seen for the number of orphans per 100,000 children.
 
Conclusions/Implications
This study completes the pictures of orphans due to cancer. It helps increase awareness of the intergenerational impact of cancer deaths, highlighting the needs for the reduction in avoidable cancer deaths and research needs for the impacted generation.

Number of new paternal orphans due to cancer per 100,000 children in 2020