The crucial role of early cancer diagnosis in improving child survival rates is a topic that deserves our attention. This groundbreaking study, led by researchers from UCL and Fondazione IRCCS Istituto Nazionale dei Tumori in Milan (INT), has shed light on a critical aspect of pediatric cancer care.
For the first time, we have detailed insights into how far children's cancer has progressed at the time of diagnosis, allowing for meaningful comparisons between countries. While it's well-known that late-stage diagnosis leads to poorer survival rates, this study goes a step further, revealing that differences in tumor stage at diagnosis may explain the variations in childhood cancer survival across different European regions and tumor types.
Published in JAMA Network Open, the researchers analyzed high-quality data from over 9,000 children across 73 cancer registries in 27 countries, mainly European. They focused on six specific cancers: neuroblastoma, Wilms tumor, medulloblastoma, osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma. The findings were clear: survival at three years was strongly linked to the stage of the tumor at diagnosis, with survival rates decreasing as the stage advanced.
Using Central Europe as a benchmark, the study revealed significant variations in overall three-year survival rates for four of these cancers across different regions. For instance, children with neuroblastoma in the UK and Ireland had lower survival rates compared to Central Europe, a difference attributed to the later stage at which the cancer was diagnosed. Interestingly, for Ewing sarcoma, the lower survival rate in Eastern Europe and the UK and Ireland couldn't be solely explained by later diagnosis. The researchers suggested that other factors, such as the extent of tumor spread and treatment approaches, might be at play.
The lack of reliable data on tumor stage at diagnosis has been a significant hurdle in understanding the differences in child cancer survival rates across countries. However, the International Benchmarking of Childhood Cancer Survival by Stage (BENCHISTA) project, led by UCL and INT researchers, has revolutionized this. Through an 18-month agreement, 23 European countries, along with Brazil, Canada, Australia, and Japan, improved their data collection techniques to ensure a consistent and reliable recording of tumor stage for at least 90% of child cancer cases.
This improved data collection has positioned researchers to better understand the regional variations in childhood cancer survival rates and guide efforts to improve them. The findings emphasize the need to examine other factors, such as treatment approaches, access to specialized care, and health system differences.
Joint senior author Professor Kathy Pritchard-Jones (UCL Great Ormond Street Institute of Child Health) highlighted the significance of these findings: "Our study shows that early and accurate diagnosis is crucial for improving survival rates for many children with cancer. However, it also underscores that early diagnosis is not the only factor; we must address other contributing factors to tackle all disparities."
The BENCHISTA project's corresponding author, Dr. Laura Botta, a statistician at INT's Evaluative Epidemiology Unit, emphasized the importance of high-quality data and collaboration: "Our project not only highlights the need for robust data and cooperation between clinicians and cancer registries but also provides a tool to uncover the reasons behind survival differences for children with cancer across countries. Our results provide the first international evidence that, in some countries, pediatric tumors are diagnosed at more advanced stages, impacting prognosis."
The study's impact extends beyond its findings. It provides unbiased evidence for the need to implement cancer-specific strategies and broader improvements in diagnosis and care. Funding for this study came from Children with Cancer UK and Associazione Italiana per la Ricerca sul Cancro (AIRC), with additional support for two researchers from the National Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre.
Gavin Maggs, Chief Executive of Children with Cancer UK, emphasized the study's importance: "BENCHISTA demonstrates how internationally comparable data can guide global efforts to ensure early diagnosis and timely care for children with cancer."
Ashley Ball-Gamble, chief executive of CCLG: The Children & Young People's Cancer Association, highlighted the study's confirmation of diagnosis delays in the UK for some childhood cancers, emphasizing the need for faster recognition campaigns.
Angela Polanco, the project's patient and public involvement lead, whose daughter Bethany was diagnosed with Wilms tumor, stressed the importance of timely and accurate diagnosis, appropriate treatment, and specialized care for all children affected by cancer.
While the study provides valuable insights, it's important to note some limitations. As with many rare disease studies, the relatively small number of cases and the three-year follow-up period may not fully capture longer-term survival differences.
This study serves as a call to action, urging us to address the disparities in childhood cancer survival rates and work towards improving diagnosis, treatment, and care for all children affected by this devastating disease.
