As reported in The Lancet, Allemani et al identified findings in the CONCORD-4 study indicating the degree of progress towards the World Health Organization (WHO) Global Initiative for Childhood Cancer (GICC) target of 60% 5-year survival for all childhood cancers combined by the year 2030.
Study Details
The 2018 WHO Global Initiative for Childhood Cancer set a goal for worldwide 5-year survival for all childhood cancers combined to reach 60% by 2030. CONCORD-4 assessed progress towards this target using population-based cancer registries from members of the International Association of Cancer Registries and other sources to obtain individual records for all children aged 0 to 14 years diagnosed with any form of cancer between 1990 and 2019. The collected data included demographic variables, morphological type and anatomical location of the tumor, and the follow-up for the vital status of each child. The 5-year net survival was estimated by age, sex, and type of cancer; a Cancer Survival Index (CSI) was developed as a weighted average of survival estimates for each country/region and each 5-year period.
Key Findings
Individual records were obtained for children from 307 population-based cancer registries in 68 countries and territories, including 52 with 100% national coverage. Survival analysis involved 613,021 children diagnosed during 1990 to 2019; two sets of weights (by age, sex, and type of cancer) were used to assess 5-year CSI among all children and among those with any of the six WHO tracer cancers.
The 5-year CSI for all childhood cancers combined increased in most countries between 1990 and 2019. For children diagnosed during 2015 to 2019, the CSI was more than 80% in most high-income countries, 60% to 80% in most upper–middle-income countries, and 50% to 60% in five participating lower–middle-income countries.
Six WHO tracer cancers were identified: acute lymphoblastic leukemia, Burkitt lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumor, and low-grade glioma. Trends in the 5-year CSI for these six WHO tracer cancers combined from 1990 to 1994 to 2015 to 2019 were similar to those for all childhood cancers combined, but typically 5% to 10% higher.
The investigators concluded: “The new CSI enables quantitative international comparison of trends in survival for all childhood cancers combined and for the six WHO tracer cancers, through a simple three-way standardization by age, sex and subtype. The CSI should be a useful tool to monitor future trends. In most high-income, upper–middle-income, and lower–middle-income countries participating in CONCORD-4, the all-cancers CSI was either close to or had already passed the GICC target to reach 60% 5-year survival for all childhood cancers combined, worldwide, by 2030. The GICC target therefore may not be ambitious enough.”
Claudia Allemani, PhD, of the Cancer Survival Group, London School of Hygiene and Tropical Medicine, is the corresponding author for The Lancet article.
DISCLOSURE: The study was funded by Cancer Research UK, Institut National du Cancer, St Jude Children’s Research Hospital, National Cancer Institute, and Dell Technologies. For full disclosures of the study authors, visit thelancet.com.
