EUROCARE-5: Trends in Survival for Childhood Cancers
As reported in The Lancet Oncology by Gatta et al, the population-based EUROCARE-5 study has shown improved survival for all childhood cancers combined in Europe between 1999–2001 and 2005–2007 and persistence of regional survival disparities.
Study Details
The study involved analysis of survival data for 59,579 children aged 0 to 14 years from 74 population-based cancer registries in 29 countries. Diagnostic categories in the analysis consisted of acute lymphoblastic leukemia, acute myeloid leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, Burkitt’s lymphoma, all central nervous system (CNS) cancers, ependymoma, astrocytoma, embryonal CNS tumors, neuroblastoma, retinoblastoma, renal tumors, osteosarcoma, Ewing’s sarcoma, and rhabdomyosarcoma.
Survival Rates
For all cancers combined for children diagnosed in 2000–2007, 1-year survival was 90.6%, 3-year survival was 81.0%, and 5-year survival was 77.9%. Five-year survival was 84% to 95% for most hematologic cancers, with survival in acute myeloid leukemia being lower, at 62.7%. Five-year survival was 57.5% for CNS cancers, with little difference among diagnostic categories.
Changes in Rates
For all cancers, 5-year survival increased from 76.1% in 1999–2001 to 79.1% in 2005–2007, with hazard ratios (HRs) falling significantly each year for all Europe (0.973, P < .0001) and in northern, central, and eastern Europe and UK/Ireland (HRs = 0.966-0.979, P < .05 for all), with a borderline significant reduction in southern Europe (HR = .967, P = .057). Five-year survival for acute lymphoblastic leukemia improved significantly from 82.2% to 87.6% in all Europe (HR = 0.939, P < .001) and improved significantly in northern Europe, eastern Europe, and UK/Ireland.
Survival also increased significantly for acute myeloid leukemia in all Europe, from 63.3% to 64.4% (HR = 0.959, P = .003), and in central Europe, and for non-Hodgkin lymphoma, from 80.1% to 85.1% in all Europe (HR = 0.940, P = .009), and in eastern Europe. Survival increased significantly for Burkitt’s lymphoma in eastern Europe and for neuroblastoma in northern Europe. No significant improvement in survival was observed for all Europe or any region in any other diagnostic category.
Regional Rates
For 2005–2007, 5-year survival for all cancers excluding CNS tumors was highest in Austria, Norway, and Switzerland (> 84%). In other northern European countries, survival rates were > 80% for Denmark, Finland, and Sweden and 75% in Iceland (based on few cases). All eastern European countries except Poland (80%) had low survival rates, including 70% to 78% in Estonia, Hungary, Latvia, and Slovakia, and 60% to 65% in Bulgaria and Lithuania. All other central European countries besides Austria and Switzerland also had rates > 80%. Among southern European countries, Croatia, Italy, Malta, and Slovenia had rates > 80% and Portugal and Spain had rates of approximately 78%. Rates were 80% or greater in Ireland, UK and Wales, and Northern Ireland and 78% in Scotland.
The investigators concluded: “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.”
Gemma Gatta, MD, of Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, is the corresponding author for the Lancet Oncology article.
The study was funded by the Italian Ministry of Health, European Commission, and Compagnia di San Paolo Foundation.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
