title: Access to principal treatment centres and survival rates for children and young people with cancer in Yorkshire, UK.
abstract: Principal Treatment Centres (PTC) were established to provide age-appropriate care as well as clinical expertise for children and young people with cancer. However, little is known about the effects of specialist treatment centres on survival outcomes especially for teenagers and young adults. This population-based study aimed to describe access to PTC and the associated trends in survival for 0-24 year olds accounting for stage of disease at presentation and treatment.
  
  
  
  Patients diagnosed from 1998-2009 aged 0-24 years were extracted from the Yorkshire Specialist Register of Cancer in Children and Young People, including information on all treating hospitals, followed-up until 31st December 2014. The six commonest cancer types were included: leukaemia (n = 684), lymphoma (n = 558), CNS tumours (n = 547), germ cell tumours (n = 364), soft tissue sarcomas (n = 171) and bone tumours (n = 163). Treatment was categorised into three groups: 'all', 'some' or 'no' treatment received at a PTC. Treatment at PTC was examined by diagnostic group and patient characteristics. Overall survival was modelled using Cox regression adjusting for case-mix including stage, treatment and other socio-demographic and clinical characteristics.
  
  
  
  Overall 72% of patients received all their treatment at PTC whilst 13% had no treatment at PTC. This differed by diagnostic group and age at diagnosis. Leukaemia patients who received no treatment at PTC had an increased risk of death which was partially explained by differences in patient case-mix (adjusted Hazard Ratio (HR) = 1.73 (95%CI 0.98-3.04)). Soft tissue sarcoma patients who had some or no treatment at PTC had better survival outcomes, which remained after adjustment for patient case-mix (adjusted HR = 0.48 (95%CI 0.23-0.99)). There were no significant differences in outcomes for other diagnostic groups (lymphoma, CNS tumours, bone tumours and germ cell tumours). For leukaemia patients survival outcomes for low risk patients receiving no treatment at PTC were similar to high risk patients who received all treatment at PTC, implying a benefit for care at the PTC.
  
  
  
  This study demonstrates that for leukaemia patients receiving treatment at a PTC is associated with improved survival that may compensate for a poorer prognosis presentation. However, further information on risk factors is needed for all diagnostic groups in order to fully account for differences in patient case-mix.
authors.affiliation: Division of Epidemiology and Biostatistics, School of Medicine, Worsley Building, University of Leeds, Clarendon Way, Leeds, UK, LS2 9JT. l.fairley@leeds.ac.uk.
authors.forename: Lesley
authors.identifier: 0000-0002-4280-6323
authors.initials: L
authors.lastname: Fairley
authors.affiliation: St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Beckett Street, Leeds, LS9 7TF, UK.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Stark
authors.affiliation: Paediatric Oncology and Haematology Department, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Yeomanson
authors.affiliation: St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Beckett Street, Leeds, LS9 7TF, UK.|Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: Sally E
authors.initials: SE
authors.lastname: Kinsey
authors.affiliation: St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Bexley Wing, St James's Hospital, Beckett Street, Leeds, LS9 7TF, UK.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Glaser
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: Susan V
authors.initials: SV
authors.lastname: Picton
authors.affiliation: Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Evans
authors.affiliation: Division of Epidemiology and Biostatistics, School of Medicine, Worsley Building, University of Leeds, Clarendon Way, Leeds, UK, LS2 9JT.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Feltbower
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D012042:Registries; D015996:Survival Rate; D006113:United Kingdom; D055815:Young Adult
keywords: Children; Principal Treatment Centres; Specialisation; Survival; Teenager and young adult