BACKGROUND: Survival and cure rates for childhood cancers in Europe have greatly improved
over the past 40 years and are mostly good, although not in all European countries.
The EUROCARE-5 survival study estimates survival of children diagnosed with cancer
between 2000 and 2007, assesses whether survival differences among European countries
have changed, and investigates changes from 1999 to 2007. METHODS: We analysed survival
data for 157,499 children (age 0-14 years) diagnosed between Jan 1, 1978 and Dec 31,
2007. They came from 74 population-based cancer registries in 29 countries. We calculated
observed, country-weighted 1-year, 3-year, and 5-year survival for major cancers and
all cancers combined. For comparison between countries, we used the corrected group
prognosis method to provide survival probabilities adjusted for multiple confounders
(sex, age, period of diagnosis, and, for all cancers combined without CNS cancers,
casemix). Age-adjusted survival differences by area and calendar period were calculated
with period analysis and were given for all cancers combined and the major cancers.
FINDINGS: We analysed 59,579 cases. For all cancers combined for children diagnosed
in 2000-07, 1-year survival was 90.6% (95% CI 90.2-90.9), 3-year survival was 81.0
% (95% CI 80.5-81.4), and 5-year survival was 77.9% (95% CI 77.4-78.3). For all cancers
combined, 5-year survival rose from 76.1% (74.4-77.7) for 1999-2001, to 79.1% (77.3-80.7)
for 2005-07 (hazard ratio 0.973, 95% CI 0.965-0.982, p<0.0001). The greatest improvements
were in eastern Europe, where 5-year survival rose from 65.2% (95% CI 63.1-67.3) in
1999-2001, to 70.2% (67.9-72.3) in 2005-07. Europe-wide average yearly change in mortality
(hazard ratio) was 0.939 (95% CI 0.919-0.960) for acute lymphoid leukaemia, 0.959
(0.933-0.986) for acute myeloid leukaemia, and 0.940 (0.897-0.984) for non-Hodgkin
lymphoma. Mortality for all of Europe did not change significantly for Hodgkin's lymphoma,
Burkitt's lymphoma, CNS tumours, neuroblastoma, Wilms' tumour, Ewing's sarcoma, osteosarcoma,
and rhabdomyosarcoma. Disparities for 5-year survival persisted between countries
and regions, ranging from 70% to 82% (for 2005-07). INTERPRETATION: Several reasons
might explain persisting inequalities. The lack of health-care resources is probably
most important, especially in some eastern European countries with limited drug supply,
lack of specialised centres with multidisciplinary teams, delayed diagnosis and treatment,
poor management of treatment, and drug toxicity. In the short term, cross-border care
and collaborative programmes could help to narrow the survival gaps in Europe. FUNDING:
Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation.
