title: Cancer in children and adolescents in Spain: incidence, treatment setting and provider specialty.
abstract: OBJECTIVE
  To analyze cancer incidence, distribution of malignancy, treatment setting and provider specialty of cancer patients, 0-19 years old, in the Comunitat Valenciana, Spain.
  
  
  METHODS
  All incident childhood and adolescent (0-19 years) cancer cases registered in the population-based Comunitat Valenciana Childhood Cancer Registry (RTICV) from 2007 to 2010 were included. Pathological and hematological diagnoses were recoded using the International Classification of Childhood Cancer Third Edition (ICCC-3). Treatment setting and provider specialty were analyzed.
  
  
  RESULTS
  696 patients <20 years were diagnosed with cancer: 513 cases were children (0-14 years) and 183 were adolescents (15-19 years). Overall age-adjusted incidence for 2007-2010 was 176.0 cases per million (95 % CI 162.8-189.2), with incidence being the highest among infants (287.4), followed by 1-4 years (205.5), adolescents (179.9), 10-14 years (150.2) and 5-9 years (140.6). Among adolescents aged 14-19 years, the treatment setting differed by cancer type; 87 % of them were never seen at pediatric oncology units, while 40 % were treated in up to 20 different medical oncology departments in institutions without pediatric oncology expertise.
  
  
  CONCLUSIONS
  This is the first population-based epidemiological study carried out in Spain on children and adolescents with cancer. Centralization of care to a small number of specialized centers and thorough pediatric and oncology team collaboration are needed to improve care and survival for adolescents with cancer in our country. We suggest the creation of specific adolescent tumor boards in main tertiary care hospitals, in which adolescents with cancer can benefit from the shared expertise of medical and pediatric specialists.
authors.affiliation: Pediatric Oncology Unit, Hospital La Fe, Avda Fernando Abril Martorell, no. 106, 46026, Valencia, Spain. berlanga_pab@gva.es.|Cancer Clinical and Translational Research Group, Health Research Institute La Fe, Valencia, Spain. berlanga_pab@gva.es.
authors.forename: P
authors.initials: P
authors.lastname: Berlanga
authors.affiliation: Public Health Directorate General, Valencian Government Health Department, Valencia, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: Vicente
authors.affiliation: Pediatric Oncology Unit, Hospital La Fe, Avda Fernando Abril Martorell, no. 106, 46026, Valencia, Spain.|Cancer Clinical and Translational Research Group, Health Research Institute La Fe, Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Cañete
authors.affiliation: Public Health Directorate General, Valencian Government Health Department, Valencia, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Alberich
authors.affiliation: Cancer Clinical and Translational Research Group, Health Research Institute La Fe, Valencia, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Castel
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D013030:Spain / Q000453:epidemiology; D013038:Specialization / Q000706:statistics & numerical data; D000078329:Workforce; D055815:Young Adult
keywords: Adolescent; Cancer incidence; Children; Population-based cancer registries; Spain; Treatment setting