Gemma Gatta1, Laura Botta2, Silvia Rossi3, Tiiu Aareleid4, Magdalena Bielska-Lasota5, Jacqueline Clavel6, Nadya Dimitrova7, Zsuzsanna Jakab8, Peter Kaatsch9, Brigitte Lacour10, Sandra Mallone3, Rafael Marcos-Gragera11, Pamela Minicozzi12, Maria-José Sánchez-Pérez13, Milena Sant12, Mariano Santaquilani3, Charles Stiller14, Andrea Tavilla3, Annalisa Trama2, Otto Visser15, Rafael Peris-Bonet16. 1. Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy. Electronic address: gemma.gatta@istitutotumori.mi.it. 2. Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy. 3. Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy. 4. Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia. 5. National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland. 6. INSERM UMRS1018, Paris-Sud University, Villejuif, France; National Registry of Childhood Hematopoietic Malignancies, Villejuif, France. 7. Bulgarian National Cancer Registry, National Oncology Hospital, Sofia, Bulgaria. 8. Hungarian Childhood Cancer Registry, 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary. 9. German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany. 10. INSERM UMRS1018, Paris-Sud University, Villejuif, France; French National Registry of Childhood Solid Tumours, CHU, Nancy, France. 11. Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health and Catalan Institute of Oncology, Girona, Spain. 12. Analytical Epidemiology and Health Impact Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy. 13. Escuela Andaluza de Salud Pública, Granada, Spain; CIBER de Epidemiología y Salud Pública, Madrid, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain. 14. Childhood Cancer Research Group, University of Oxford, Oxford, UK. 15. Comprehensive Cancer Center the Netherlands, Utrecht, Netherlands. 16. Spanish National Registry of Childhood Tumours (RNTI-SEHOP), University of Valencia, Valencia, Spain.
Abstract
BACKGROUND: Survival and cure rates for childhood cancers in Europe have greatly improved over the past 40 years and are mostly good, although not in all European countries. The EUROCARE-5 survival study estimates survival of children diagnosed with cancer between 2000 and 2007, assesses whether survival differences among European countries have changed, and investigates changes from 1999 to 2007. METHODS: We analysed survival data for 157,499 children (age 0-14 years) diagnosed between Jan 1, 1978 and Dec 31, 2007. They came from 74 population-based cancer registries in 29 countries. We calculated observed, country-weighted 1-year, 3-year, and 5-year survival for major cancers and all cancers combined. For comparison between countries, we used the corrected group prognosis method to provide survival probabilities adjusted for multiple confounders (sex, age, period of diagnosis, and, for all cancers combined without CNS cancers, casemix). Age-adjusted survival differences by area and calendar period were calculated with period analysis and were given for all cancers combined and the major cancers. FINDINGS: We analysed 59,579 cases. For all cancers combined for children diagnosed in 2000-07, 1-year survival was 90.6% (95% CI 90.2-90.9), 3-year survival was 81.0 % (95% CI 80.5-81.4), and 5-year survival was 77.9% (95% CI 77.4-78.3). For all cancers combined, 5-year survival rose from 76.1% (74.4-77.7) for 1999-2001, to 79.1% (77.3-80.7) for 2005-07 (hazard ratio 0.973, 95% CI 0.965-0.982, p<0.0001). The greatest improvements were in eastern Europe, where 5-year survival rose from 65.2% (95% CI 63.1-67.3) in 1999-2001, to 70.2% (67.9-72.3) in 2005-07. Europe-wide average yearly change in mortality (hazard ratio) was 0.939 (95% CI 0.919-0.960) for acute lymphoid leukaemia, 0.959 (0.933-0.986) for acute myeloid leukaemia, and 0.940 (0.897-0.984) for non-Hodgkin lymphoma. Mortality for all of Europe did not change significantly for Hodgkin's lymphoma, Burkitt's lymphoma, CNS tumours, neuroblastoma, Wilms' tumour, Ewing's sarcoma, osteosarcoma, and rhabdomyosarcoma. Disparities for 5-year survival persisted between countries and regions, ranging from 70% to 82% (for 2005-07). INTERPRETATION: Several reasons might explain persisting inequalities. The lack of health-care resources is probably most important, especially in some eastern European countries with limited drug supply, lack of specialised centres with multidisciplinary teams, delayed diagnosis and treatment, poor management of treatment, and drug toxicity. In the short term, cross-border care and collaborative programmes could help to narrow the survival gaps in Europe. FUNDING: Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation.
BACKGROUND: Survival and cure rates for childhood cancers in Europe have greatly improved over the past 40 years and are mostly good, although not in all European countries. The EUROCARE-5 survival study estimates survival of children diagnosed with cancer between 2000 and 2007, assesses whether survival differences among European countries have changed, and investigates changes from 1999 to 2007. METHODS: We analysed survival data for 157,499 children (age 0-14 years) diagnosed between Jan 1, 1978 and Dec 31, 2007. They came from 74 population-based cancer registries in 29 countries. We calculated observed, country-weighted 1-year, 3-year, and 5-year survival for major cancers and all cancers combined. For comparison between countries, we used the corrected group prognosis method to provide survival probabilities adjusted for multiple confounders (sex, age, period of diagnosis, and, for all cancers combined without CNS cancers, casemix). Age-adjusted survival differences by area and calendar period were calculated with period analysis and were given for all cancers combined and the major cancers. FINDINGS: We analysed 59,579 cases. For all cancers combined for children diagnosed in 2000-07, 1-year survival was 90.6% (95% CI 90.2-90.9), 3-year survival was 81.0 % (95% CI 80.5-81.4), and 5-year survival was 77.9% (95% CI 77.4-78.3). For all cancers combined, 5-year survival rose from 76.1% (74.4-77.7) for 1999-2001, to 79.1% (77.3-80.7) for 2005-07 (hazard ratio 0.973, 95% CI 0.965-0.982, p<0.0001). The greatest improvements were in eastern Europe, where 5-year survival rose from 65.2% (95% CI 63.1-67.3) in 1999-2001, to 70.2% (67.9-72.3) in 2005-07. Europe-wide average yearly change in mortality (hazard ratio) was 0.939 (95% CI 0.919-0.960) for acute lymphoid leukaemia, 0.959 (0.933-0.986) for acute myeloid leukaemia, and 0.940 (0.897-0.984) for non-Hodgkin lymphoma. Mortality for all of Europe did not change significantly for Hodgkin's lymphoma, Burkitt's lymphoma, CNS tumours, neuroblastoma, Wilms' tumour, Ewing's sarcoma, osteosarcoma, and rhabdomyosarcoma. Disparities for 5-year survival persisted between countries and regions, ranging from 70% to 82% (for 2005-07). INTERPRETATION: Several reasons might explain persisting inequalities. The lack of health-care resources is probably most important, especially in some eastern European countries with limited drug supply, lack of specialised centres with multidisciplinary teams, delayed diagnosis and treatment, poor management of treatment, and drug toxicity. In the short term, cross-border care and collaborative programmes could help to narrow the survival gaps in Europe. FUNDING: Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation.
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Authors: T de Rojas; M Puertas; F Bautista; I de Prada; M Á López-Pino; B Rivero; C Gonzalez-San Segundo; M Gonzalez-Vicent; A Lassaletta; L Madero; L Moreno Journal: Clin Transl Oncol Date: 2019-04-01 Impact factor: 3.405
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