Childhood central nervous system tumour mortality and survival in Southern and Eastern Europe (1983-2014): Gaps persist across 14 cancer registries.
OBJECTIVE
Childhood central nervous system (CNS) tumour registration and control programs in Southern and Eastern Europe remain thin, despite the lethal nature of the disease. Mortality/survival data were assembled to estimate the burden of malignant CNS tumours, as well as the potential role of sociodemographic survival determinants across 14 cancer registries of this region.


METHODS
Average age-adjusted mortality rates were calculated, whereas time trends were quantified through Poisson and Joinpoint regressions. Kaplan-Meier curves were derived for the maximum and the more recent (10 and 5 year) registration periods. Multivariate Cox regression models were used to assess demographic and disease-related determinants.


RESULTS
Variations in mortality (8-16 per million) and survival (5-year: 35-69%) were substantial among the participating registries; in most registries mortality trend was stable, whereas Bulgaria, having the highest starting rate, experienced decreasing annual mortality (-2.4%, p=0.001). A steep decrease in survival rates was evident before the second year of follow-up. After controlling for diagnostic subgroup, age, gender and diagnostic year, Greece seemed to present higher survival compared with the other contributing registries, although the follow-up period was short. Irrespective of country, however, rural residence was found to impose substantial adverse repercussions on survival (hazard ratio (HR): 1.2, 95% confidence interval (CI): 1.1-1.4).


CONCLUSIONS
Cross-country mortality and survival variations possibly reflect suboptimal levels of health care delivery and cancer control in some regions of Southern and Eastern Europe, notwithstanding questionable death certification patterns or follow-up procedures. Continuous childhood cancer registration and linkage with clinical data are prerequisite for the reduction of survival inequalities across Europe.
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
Maria A
MA
Karalexi
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
Paraskevi
P
Papathoma
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
Thomas P
TP
Thomopoulos
National Cancer Registry of Ukraine, National Institute of Cancer, Kyiv, Ukraine.
Anton
A
Ryzhov
Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Childhood Cancer Subregistry of Belarus, Minsk, Belarus.
Anna
A
Zborovskaya
Bulgarian National Cancer Registry, National Oncology Hospital, Sofia, Bulgaria.
Nadya
N
Dimitrova
Institute of Public Health of Serbia, Belgrade, Serbia.
Snezana
S
Zivkovic
Izmir Cancer Registry, Izmir Hub, Izmir & Hacettepe University Institute of Public Health, Ankara, Turkey.
Sultan
S
Eser
North Region Cancer Registry of Portugal (NORTH), Portuguese Oncology Institute of Porto, Portugal.
Luís
L
Antunes
Croatian National Cancer Registry, Croatian Institute of Public Health, Zagreb, Croatia.
Mario
M
Sekerija
Cancer Registry of Republic of Slovenia, Institute of Oncology, Ljubljana, Slovenia.
Tina
T
Zagar
Registo Oncológico Regional do Centro, Instituto Português de Oncologia de Coimbra Francisco Gentil E.P.E, Coimbra, Portugal.
Joana
J
Bastos
Cyprus Cancer Registry-Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus.
Anna
A
Demetriou
Malta National Cancer Registry, Department of Health Information and Research, Malta.
Domenic
D
Agius
Epidemiology, Institute of Public Health, 16-18 Victor Babes Street, Timisoara 300226, Romania.
Raluca
R
Cozma
Regional Cancer Registry of Cluj, Oncological Institute "Ion Chiricuta", Cluj-Napoca, Romania.
Daniela
D
Coza
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
Evdoxia
E
Bouka
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
Nick
N
Dessypris
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
Maria
M
Belechri
Oncology Department, "Mitera" Childrens Hospital, Erythrou Stavrou 6 Marousi, Athens, Greece.
Helen
H
Dana
2nd Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece.
Emmanuel
E
Hatzipantelis
Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki, Greece.
Evgenia
E
Papakonstantinou
Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece.
Sophia
S
Polychronopoulou
Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Athens, Greece.
Apostolos
A
Pourtsidis
Department of Pediatric Hematology-Oncology, University of Crete, University Hospital of Heraklion, Heraklion, Greece.
Eftichia
E
Stiakaki
First Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece.
Achilles
A
Chatziioannou
Department of Neurosurgery, University Hospital of Heraklion, Heraklion, Crete, Greece.
Katerina
K
Manolitsi
Department of Neurosurgery, G. Gennimatas General Hospital, Athens, Greece.
Georgios
G
Orphanidis
Department of Pathology, Hygeia Hospital, Athens, Greece.
Savvas
S
Papadopoulos
2nd Department of Radiology, Radiotherapy Unit, Medical School, National Kapodistrian University of Athens, Athens, Greece.
Mathilda
M
Papathanasiou
Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Eustratios
E
Patsouris
Department of Neurosurgery, "Mitera" Childrens Hospital, Erythrou Stavrou 6 Marousi, Athens, Greece.
Spyros
S
Sgouros
Department of Neurosurgery, St. Luke's Hospital, Panorama, Thessaloniki.
Basilios
B
Zountsas
Haematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece.
Maria
M
Moschovi
Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
Eva
E
Steliarova-Foucher
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece. Electronic address: epetrid@med.uoa.gr.
Eleni Th
ET
Petridou
D000293:Adolescent; D016543:Central Nervous System Neoplasms / Q000145:classification / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005843:Geography; D006801:Humans; D007223:Infant; D008297:Male; D009026:Mortality / Q000639:trends*; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D015996:Survival Rate; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data
Cancer registries; Central Nervous System tumours; Child; Disparities; Economic status; Health care delivery; Mortality; Survival; Urbanisation