Elsevier

European Journal of Cancer

Volume 42, Issue 13, September 2006, Pages 1981-2005
European Journal of Cancer

Trends in survival after childhood cancer in Europe, 1978–1997: Report from the Automated Childhood Cancer Information System project (ACCIS)

https://doi.org/10.1016/j.ejca.2006.05.006Get rights and content

Abstract

This study, originating in the Automated Childhood Cancer Information System (ACCIS), evaluated the time trend in survival after childhood cancer in Europe. The study included more than 72,000 childhood cancer cases aged 0–14 years diagnosed in 1978–1997 and followed-up in 30 population-based cancer registries with a long history of registration and follow-up, in 15 European countries. Survival was analysed using an actuarial life-table method. Five-year cumulative survival probability increased significantly over the study period for all tumour types combined, from 54% for cases diagnosed in the period 1978–1982 to 75% in 1993–1997. Significant improvement was also observed in 10-year survival. Comparing the results for the period 1993–1997 with those for 1978–1982, the largest relative increase in survival was seen for hepatic tumours (32%) and the largest reduction in mortality for non-Hodgkin’s lymphomas (60%). Least progress was seen for central nervous system (CNS) tumours. The improvement was statistically significant in all European regions and was most rapid in the East. The ranking among the European regions did not change over the study period, with highest survival in the North and the West and lowest in the East. Extended data collection is necessary to evaluate future time trends and changes in differences between European regions.

Introduction

During the last 40 years survival after childhood malignant tumours has improved in most developed countries.1, 2, 3, 4, 5, 6, 7, 8, 9 Marked decreases in cancer mortality rates were correspondingly observed in children and young adults in Europe during the period 1955–1995.10 The improved prognosis was observed to a various extent for all major types of childhood tumours. It was attributed to improved treatment protocols,11, 12 diagnostic procedures12, 13 and organisation.14

The aim of this study is to describe the changes in long-term population-based survival of childhood cancer patients in Europe and identify further possibilities for improvement, using the large database of the Automated Childhood Cancer Information System (ACCIS).15 The ACCIS database contains data from 78 population-based cancer registries that cover about 50% of the population aged 0–14 years living in the 35 participating countries. The present analyses of survival time trends are based on a subset of over 72,000 childhood cancer cases, diagnosed between 1978 and 1997 in 30 cancer registries, with quality data, long-term registration and follow-up, in 15 countries. The time trends are presented for childhood cancer overall and for major tumour groups; for a combined European data-set and five defined geographical regions.

Section snippets

Material and methods

All malignant neoplasms, together with non-malignant tumours of the central nervous system (CNS), diagnosed in children aged 0–14 years during the period 1978–1997 in selected registries were extracted from the ACCIS database. The registries were selected if they contributed at least 15 years of registration during 1978–1997 and comparable data-sets, as evaluated by the ACCIS Scientific Committee [Steliarova-Foucher, Kaatsch, Lacour and colleagues, this issue]. Two other registries (Somme, and

Results

A total of 75,572 childhood cancer cases were registered in the 30 selected registries of 15 European countries over the study period 1978–1997. Of these, 72,398 (96%) were followed-up for a period ranging from 1 day to 22 years, and thus included in survival analyses. The proportion of cases contributing to the analyses of survival in each registry can be evaluated from Table 1. The 3174 cases with no follow-up included 239 (8%) DCO cases. In the analyses of leukaemia, the 148 leukaemia cases

Discussion

This study investigated the changes in survival of European children diagnosed with malignant neoplasms in 1978–1997. A considerable improvement in survival of children with cancer was observed, with an almost 50% percent reduction in mortality by 5 years over the study period. This favourable trend was seen for all tumour types and in all regions of Europe.

Using the population-based ACCIS database, only cancer registries with long registration periods were selected. The geographical variety of

Conflict of interest statement

None declared.

Acknowledgements

The ACCIS project was funded by the European Commission from ‘Europe Against Cancer’ action programme (1996–2002) (contracts SI2.126875, SI2.321970 and SPC.2002303), jointly with International Agency for Research on Cancer. Data analyses were partly financed by the French Ligue National Contre le Cancer, Comité du Rhône. The activity of S.V. was supported by CPO-Piemonte (intramural research activity financed by the Piemonte Region).

The authors thank Mr Nicolas Mitton for his input to the

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