Population survival from childhood cancer in Britain during 1978–2005 by eras of entry to clinical trials

• Published in: Annals of oncology Vol. 23; no. 9; pp. 2464 - 2469
• Main Authors: Stiller, C.A., Kroll, M.E., Pritchard-Jones, K.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.2012; Oxford University Press
• Subjects: Adolescent; Antineoplastic agents; Biological and medical sciences; cancer registry; Child; Child, Preschool; childhood cancer; clinical trials; Clinical Trials as Topic - history; Clinical Trials as Topic - statistics & numerical data; Clinical Trials as Topic - trends; Female; History, 20th Century; History, 21st Century; Humans; Infant; Male; Medical sciences; Neoplasms - history; Neoplasms - mortality; Neoplasms - therapy; Pharmacology. Drug treatments; population-based; Quality Improvement; Registries; survival; Survival Analysis; Treatment Outcome; trends; United Kingdom - epidemiology; United Kingdom; Great Britain; Europe; cancer registry; childhood cancer; clinical trials; population-based; trends; survival; Human; Malignant tumor; Survival; Register; Clinical trial; Child; Public health; Cancer
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mds183

Inclusion in clinical trials is generally viewed as best practice for most newly diagnosed childhood cancers, but the impact on population-based survival has rarely been examined. The population-based data were analysed for 25853 children (66% of all registered childhood cancers) diagnosed in Britain during 1978–2005 with acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML), Hodgkin lymphoma, non-Hodgkin lymphoma, medulloblastoma, neuroblastoma, Wilms tumour, hepatoblastoma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma and germ-cell tumours. The Kaplan–Meier survival curves were compared by log-rank tests. Time trends were analysed by Cox regression. Separate analyses were done for children with ALL, medulloblastoma and neuroblastoma according to clinically relevant age thresholds. Survival increased significantly during 1978–2005 for every diagnostic category; the annual reduction in risk of death ranged from 2.7% (rhabdomyosarcoma) to 12.0% (gonadal germ-cell tumours). Survival increased steadily between trial eras for ALL (age 1–14years) and neuroblastoma (age 1–14years), but changed little since the mid-1980s for medulloblastoma (age 0–2years), osteosarcoma or Ewing sarcoma. Changes in survival between trial eras parallel those reported by the relevant clinical trials. The increasing level of participation in trials, facilitated by the organisation of specialist care, has underpinned the substantial improvements in survival seen at the population level.