Contact: Margaret Willson
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European Society for Medical Oncology

The Nordic countries of Sweden, Norway, Finland and Iceland, represent a gold standard for the treatment of children's cancer. They have survival rates to which all European countries that devote similar resources and have comparable health systems can aspire, according to research published today (18 December 2003) in Annals of Oncology[1].

The findings are part of the 160-page EUROCARE-3 report 'Cancer survival in Europe at the end of the 20th century'. EUROCARE's top-line results for adult cancer survival were presented in September to the European Cancer Conference but the entire report with a country by country and cancer by cancer breakdown is published today as a supplement by Annals of Oncology, and the survival results for children's cancer are being made public for the first time[2].

The paediatric section of the report - 'Childhood cancer survival in Europe' - analyses survival over 23,000 children diagnosed between 1990 and 1994 and under the age of 15 at diagnosis. It took data from 45 cancer registries in 20 countries. The report, like the rest of EUROCARE-3, was co-ordinated by the Epidemiology Unit of the Istituto Nazionale Tumori in Milan, Italy.

Lead author Dr Gemma Gatta, medical doctor and epidemiologist, said: 'We found large variations in overall cancer survival for children, ranging from a low of 45% in Estonia to a high of 90% in Iceland.'

In western Europe the range was from 71% to 81%. In the eastern European countries (Czech Republic, Poland, Slovenia and Slovakia) it was 63% to 66%. Germany, Switzerland and the Nordic countries (except Denmark) had high survival figures at around an average 80%. In particular, Dr. Gatta said, the Nordic countries had the highest survival for four of the seven major childhood tumour type: Wilms' tumour (92%), acute lymphoid leukaemia (85%), central nervous system tumours (73%) and acute non-lymphocytic leukaemia (62%). The average European five-year survival for all childhood cancers was 71.8%.

Overall childhood cancer survival rates have improved in most countries since EUROCARE-2 was published in 2001. That had looked at children diagnosed between 1978 and 1992.

'For the major childhood cancers we found a tendency for overall improvement,' said Dr Gatta. 'There were improvements of as much as 10% in neuroblastoma (a tumour of sympathetic nervous system) and Ewing's sarcoma (a tumour of the bones).'

The investigators also compared survival figures in Europe and the USA and found that, except for eastern Europe, survival was generally similar between the two continents although Europe had significantly lower survival rates for neuroblastoma and Wilms' tumour (a type of kidney cancer).

Dr. Gatta stressed that the purpose of EUROCARE-3 was not to establish league tables but to estimate the range of survival figures and to identify regions or countries in which survival could be improved.

Care had been taken to investigate and counteract possible sources of bias e.g. the researchers adjusted for the differences in the age distribution of cancer patients between different European populations. They also found that only 1.1% of the cases were lost to follow-up and the proportion of cases allocated to 'unspecified' categories was low at 3.4%.

Cancer registries involved in EUROCARE had settled on a uniform collection policy, with data checking and analytical procedures agreed in advance.

'These data quality indicate that the survival differences between the European populations we analysed are unlikely to be due to registration artefacts,' said Dr Gatta. 'As the majority of childhood cancers are curable or at least respond well to treatment, the main factors influencing survival are access to treatment and application of up-to-date treatment protocols.

Cancer survival differences could also be due to differences in the availability of resources, since these would directly influence access to and the use of more modern treatment protocols.

Similarly, hospitals in countries or areas with limited financial resources are less likely to be able to participate fully in clinical trials of new treatments both for organisational and for financial reasons. The adequacy of the early diagnosis and referral system may also have an important influence on the likelihood of timely access to treatment. This requires, among other things, awareness by paediatricians, GPs and emergency physicians of paediatric cancer.'

Dr. Gatta added: 'We conclude that survival in the Nordic countries represents a gold standard to which all countries who devote similar resources and have comparable health systems can aspire. But, for each individual country it is important to understand the obstacles to achieving better survival for childhood cancer.'

Five-year survival for all malignant childhood cancer in Europe diagnosed from 1990-1994*

Estonia - Cases 199
5-year survival(%) 44.9

Slovakia - Cases 711
5-year survival(%) 63.1

Poland - Cases 287
5-year survival(%) 63.2

Czech Republic - Cases 119
5-year survival(%) 65.3

Slovenia - Cases 228
5-year survival(%) 65.7

The Netherlands - Cases 439
5-year survival(%) 70.7

Spain - Cases 1185
5-year survival(%) 70.8

Scotland - Cases 636
5-year survival(%) 71.0

England & Wales - Cases 5835
5-year survival(%) 71.1

Denmark - Cases 630
5-year survival(%) 71.6

Europe (all) - Cases 23120
5-year survival(%) 71.8

Italy - Cases 1228
5-year survival(%) 72.3

France - Cases 1419
5-year survival(%) 72.8

Malta - Cases 23
5-year survival(%) 73.3

Austria - Cases 73
5-year survival(%) 74.2

Norway - Cases 539
5-year survival(%) 74.8

Germany - Cases 7473
5-year survival(%) 76.4

Sweden - Cases 1215
5-year survival(%) 79.4

Switzerland - Cases 43
5-year survival(%) 81.0

Finland - Cases 799
5-year survival(%) 81.2

Iceland - Cases 39
5-year survival(%) 90.1

* More statistics available in the full paper.

Notes
[1]. Childhood cancer survival in Europe. Annals of Oncology. Vol 14. Supp.5 December 2003. Pp v119-v127
[2]. EUROCARE-3: Cancer survival in Europe at the end of the 20th century. The full report can be accessed at: annonc.oupjournals/content/vol14/suppl_5/ from 18 December. NB: Several of the PDF files are very large and may take some time to download. A PDF of the childhood cancer chapter is available immediately from Margaret Willson.

Notes:
1. Annals of Oncology is the monthly journal of the European Society for Medical Oncology. Please acknowledge the journal as the source in any reports.
2. Annals of Oncology website: annonc.oupjournals
3. PDF of article available from Margaret Willson.
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