Elsevier

The Lancet Oncology

Volume 15, Issue 1, January 2014, Pages 35-47
The Lancet Oncology

Articles
Childhood cancer survival in Europe 1999–2007: results of EUROCARE-5—a population-based study

https://doi.org/10.1016/S1470-2045(13)70548-5Get rights and content

Summary

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.

Introduction

The EUROCARE project produces population-based cancer survival and related information that depicts the situation in Europe as accurately as possible. It encourages the participation of all European cancer registries that have good-quality survival data.

Survival after childhood cancers is now generally good and better than for adults. Previous EUROCARE studies estimated that during 1995–2002, 5-year all-cancer survival was 56% for adults,1 and 81% for children.2 However, large differences exist between countries: ranging from 48% to 62% for adults, and 75% to 86% for children.1, 2 Survival improved between the late 1990s and the early 2000s, particularly for acute lymphoid leukaemia and CNS cancers.2

EUROCARE-5 assessed the largest European population yet, with a much greater participation of cancer registries from eastern Europe. Here, we present EUROCARE-5 survival data for children diagnosed with cancer between 2000 and 2007, assess whether survival differences between European countries have changed, and investigate whether survival for the main childhood cancers has changed from previous periods.

Section snippets

Study design and data collection

The EUROCARE-5 database contains data for 157 499 cancers diagnosed in European children (age 0–14 years; 14 years is usually the cutoff used in studies of childhood cancer) from Jan 1, 1978, to Dec 31, 2007, with data for whether the patient is alive or date of death updated to Dec 31, 2008. The data were provided by 74 population-based cancer registries in 29 countries: Denmark, Finland, Iceland, Norway, and Sweden (grouped as northern Europe); Bulgaria, Estonia, Hungary, Latvia, Lithuania,

Results

We extracted and analysed two datasets from the EUROCARE-5 database. The first included data for 60 415 children diagnosed with cancer between 2000 and 2007 for which all 74 cancer registries had data. Table 1 shows the main characteristics by country of this dataset, with principal data quality indicators. After checking and correcting,10 836 cases were excluded (table 1). Thus, we included 59 579 cases in the analysis. Of these, 56 305 (94·5%) were microscopically verified. For most countries

Discussion

5-year survival for all cancers combined is increasing in Europe—as reported in previous EUROCARE studies2, 12—with HR falling on average by 3% per year. The most notable improvements were in eastern Europe, where 5-year survival rose from 65% in 1999–2001 to 70% in 2005–07.

Despite these improvements, there are still survival disparities between countries and European regions, but with few exceptions, survival was lowest in eastern Europe. Many factors could explain the poor survival in eastern

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