title: Childhood cancer survival in Europe 1999-2007: results of EUROCARE-5--a population-based study.
abstract: 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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation.
authors: Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy. Electronic address: gemma.gatta@istitutotumori.mi.it.
authors: Gemma
authors: G
authors: Gatta
authors: Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy.
authors: Laura
authors: L
authors: Botta
authors: Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy.
authors: Silvia
authors: S
authors: Rossi
authors: Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
authors: Tiiu
authors: T
authors: Aareleid
authors: National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
authors: Magdalena
authors: M
authors: Bielska-Lasota
authors: INSERM UMRS1018, Paris-Sud University, Villejuif, France; National Registry of Childhood Hematopoietic Malignancies, Villejuif, France.
authors: Jacqueline
authors: J
authors: Clavel
authors: Bulgarian National Cancer Registry, National Oncology Hospital, Sofia, Bulgaria.
authors: Nadya
authors: N
authors: Dimitrova
authors: Hungarian Childhood Cancer Registry, 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary.
authors: Zsuzsanna
authors: Z
authors: Jakab
authors: German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany.
authors: Peter
authors: P
authors: Kaatsch
authors: INSERM UMRS1018, Paris-Sud University, Villejuif, France; French National Registry of Childhood Solid Tumours, CHU, Nancy, France.
authors: Brigitte
authors: B
authors: Lacour
authors: Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy.
authors: Sandra
authors: S
authors: Mallone
authors: Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health and Catalan Institute of Oncology, Girona, Spain.
authors: Rafael
authors: R
authors: Marcos-Gragera
authors: Analytical Epidemiology and Health Impact Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy.
authors: Pamela
authors: P
authors: Minicozzi
authors: Escuela Andaluza de Salud Pública, Granada, Spain; CIBER de Epidemiología y Salud Pública, Madrid, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain.
authors: Maria-José
authors: MJ
authors: Sánchez-Pérez
authors: Analytical Epidemiology and Health Impact Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy.
authors: Milena
authors: M
authors: Sant
authors: Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy.
authors: Mariano
authors: M
authors: Santaquilani
authors: Childhood Cancer Research Group, University of Oxford, Oxford, UK.
authors: Charles
authors: C
authors: Stiller
authors: Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy.
authors: Andrea
authors: A
authors: Tavilla
authors: Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy.
authors: Annalisa
authors: A
authors: Trama
authors: Comprehensive Cancer Center the Netherlands, Utrecht, Netherlands.
authors: Otto
authors: O
authors: Visser
authors: Spanish National Registry of Childhood Tumours (RNTI-SEHOP), University of Valencia, Valencia, Spain.
authors: Rafael
authors: R
authors: Peris-Bonet
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005060:Europe; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009369:Neoplasms / Q000401:mortality*; D013997:Time Factors