Survival of European children and young adults with cancer diagnosed 1995–2002

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Abstract

This study analyses survival in 40,392 children (age 0–14 years) and 30,187 adolescents/young adults (age 15–24 years) diagnosed with cancer between 1995 and 2002. The cases were from 83 European population-based cancer registries in 23 countries participating in EUROCARE-4. Five-year survival in countries and in regional groupings of countries was compared for all cancers combined and for major cancers. Survival for 15 rare cancers in children was also analysed.

Five-year survival for all cancers combined was 81% in children and 87% in adolescents/young adults. Between-country survival differences narrowed for both children and adolescents/young adults. Relative risk of death reduced significantly, by 8% in children and by 13% in adolescents/young adults, from 1995–1999 to 2000–2002. Survival improved significantly over time for acute lymphoid leukaemia and primitive neuroectodermal tumours in children and for non-Hodgkin lymphoma in adolescents/young adults.

Cancer survival in patients <25 years is poorly documented in Eastern European countries. Complete cancer registration should be a priority for these countries as an essential part of a policy for effective cancer control in Europe.

Introduction

About 15,000 children (age 0–14 years) and 20,000 adolescents/young adults (age 15–24 years) are diagnosed with cancer each year in Europe.1 Although only 1% of all cancers are diagnosed in these age groups, they have a number of characteristics that increase their impact on society:

  • The prevalence of adults diagnosed with cancer before age 25 is increasing due to improving survival, and to a lesser extent, increasing cancer incidence.2

  • The risk of second cancers is high in adults surviving cancer diagnosed before age 25.

  • Many cancer survivors diagnosed before age 25 experience sequelae in later life that require medical treatment.

  • European populations differ markedly in cancer survival, implying inequality of access to treatment for diseases in young people which are typically highly curable.

  • Survival in adolescents/young adults is worse than in children with biologically similar cancers, probably because intensive treatment protocols have been mainly developed for children.

Survival data for young Europeans (below age 25) diagnosed with cancer between 1978 and 1994 are available in various EUROCARE publications.3, 4 The ACCIS project5 produced survival figures for European children and adolescents <20 up to diagnosis year 1997, and substantiated the disparities in survival across Europe brought to light by EUROCARE. The present EUROCARE-4 study analyses survival and survival time trends in young Europeans diagnosed with cancer between 1995 and 2002, and also examines trends in survival differences between different European populations.

Section snippets

Materials and methods

Survival was analysed for 40,392 European children (age 0–14 years) and 30,187 adolescents/young adults (age 15–24 years) diagnosed with cancer during the period 1995–2002 and followed-up at least until December 31, 2003. All cases with a malignant neoplasm, as defined by ICD for Oncology (ICD-O-3)6 behaviour code 3 or higher, were included. Only first tumours were analysed; 771 cases were excluded from the analysis as they were second or later primary tumours.

The cases were contributed by 83

All cancers combined

Five-year survival estimates by country for all cancers combined diagnosed in 1995–2002 are shown in Fig. 1 (children) and Fig. 2 (adolescents/young adults). For most countries survival in children ranged between 78% and 83%. Malta and Czech Republic had lower survival (75% and 76%, respectively), which did not, however, differ significantly from mean European survival (81%). Austria had the highest survival (86%). For adolescents/young adults, 5-year survival was 87% overall, and the range was

Discussion

The two major – and encouraging – findings of our study are that survival for all cancers combined improved significantly across Europe (more for adolescents/young adults than for children) and that the survival gap between countries reduced. Considering individual cancers, survival increased significantly for leukaemias and PNET in children, and for non-Hodgkin lymphoma in adolescents/young adults.

For all cancers combined, notable increases in survival were achieved by countries with poor

Conflict of interest statement

None declared.

EUROCARE-4 Working Group

Austria: W Oberaigner (Tyrol Cancer Registry); M Hackl (Austrian National Cancer Registry); Belgium: E Van Eycken; Martine Verstreken (Flemish Cancer Registry), Czech Republic: J Holub, L Jurickova (West Bohemia Cancer Registry); Denmark: HH Storm; G Engholm (Danish Cancer Society, Dept. Cancer Prevention & Documentation); Finland: T Hakulinen (Finnish Cancer Registry); France: A Belot (FRANCIM); G Hédelin, M Velten (Bas-Rhin Cancer Registry); I Tron, E Le Gall (Bretagne Childhood Cancer

Acknowledgements

We thank Don Ward for help with the English and Samba Sowe for editorial support. The research was supported by the Compagnia di San Paolo, Torino, Italy. The Spanish RNTI-SEHOP is in the ISCIII-RTICC RD06/0020 and receives partial support from the Scientific Foundation of the Asociación Española Contra el Cáncer and the Fundación Villavecchia.

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