title: Childhood cancer survival in Switzerland (1976-2013): Time-trends and predictors.
abstract: Population-based studies on childhood cancer survival are key to monitor progress against cancer and to detect potential differences between regions and other subgroups in the population. We investigated time trends and factors associated with childhood cancer survival on a national level in Switzerland, from 1976 to 2013. We extracted data from the population-based Swiss Childhood Cancer Registry of 5,776 children (age 0-14 years) diagnosed with cancer from 1985 to 2014 in Switzerland. We calculated age-adjusted 5-year survival, defined the annual reduction in risk of death (ARR), and explored associations of survival with clinical and demographic factors. Overall, 5-year survival improved significantly, from 64% in 1976-1983 to 88% in 2004-2013. ARR over the whole period was 4% for all diagnostic groups, greatest for Hodgkin lymphomas (8%), ependymomas (6%), Burkitt's lymphomas (6%) and germ cell tumours (6%). Children treated in hospitals without specialised paediatric cancer centre for leukaemia (HR 12.9), lymphoma (HR 5.0) and neuroblastoma (HR 3.7) were at higher risk of death. In French-speaking Switzerland, risk of death was lower for lymphoma (HR 0.6), CNS tumours (HR 0.7) and neuroblastoma (HR 0.5). Children with migration background had a higher risk of death from all tumours except bone tumours. Childhood cancer survival significantly improved from 1976 to 2013, but there is room for further improvement. Survival rates varied by type of clinical treatment, language region and nationality. All paediatric cancer patients should be referred to a specialised paediatric cancer centre. Further research is needed to intervene and completely eliminate inequalities in survival.
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland.
authors.forename: Matthias
authors.identifier: http://orcid.org/0000-0001-7232-693X
authors.initials: M
authors.lastname: Schindler
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland.
authors.forename: Fabiën N
authors.initials: FN
authors.lastname: Belle
authors.affiliation: Department of Oncology, University Children's Hospital of Zürich, Steinwiesstrasse 75, CH-8032 Züerich, Switzerland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Grotzer
authors.affiliation: Department of Paediatric Oncology and Haematology, University Children's Hospital Basel UKKB, Spitalstrasse 33, CH-4056 Basel, Switzerland.
authors.forename: Nicolas X
authors.initials: NX
authors.lastname: von der Weid
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland.
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Kuehni
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate / Q000639:trends*; D013557:Switzerland / Q000453:epidemiology
keywords: Europe; childhood cancer; suggestion: Swiss Childhood Cancer Registry; surivival; time-trends