Childhood cancer survival rates still vary across Europe and other developed countries, but the reasons why are not fully understood. Until now, teasing out the clues that could explain these variations has not been feasible. This is due to the lack of information on how far cancers have spread at diagnosis (tumour stage) and the different ways that this is recorded in different countries. Prof. Kathy Pritchard-Jones and her international team will overcome this issue by standardising cancer data on tumour stage across multiple European countries and further abroad to allow meaningful comparisons. Their findings could help countries to understand and improve childhood cancer survival rates in their own nations.
“BENCHISTA” - Benchmarking International Survival by Toronto stAge
Prof. Kathy Pritchard-Jones and Dr Gemma Gatta
University College London, UCL Great Ormond Street Institute of Child Health; and Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan
London, WC1N 1EH; and Milan, 20133 Milano MI
1 January 2021
We know that childhood cancer survival chances vary between countries. The chance of a child being cured is affected by how far their cancer has spread at the time they are diagnosed. For solid tumours, measurement of this cancer spread is called ‘tumour stage’: at its most simple, low numbers (stages 1 and 2) mean the cancer is still where it started in the body, high numbers (stage 3 and 4) mean that it has invaded nearby structures or spread to distant parts of the body.
Cancer registries (CRs) count all the new cases of cancer in a population and follow up patients to know if they survive. This is called ‘overall survival’ and is measured for all people with cancer. If there are differences in survival rates between populations, this might be explained by differences in the numbers of patients with ‘low’ versus ‘high’ stage tumours at diagnosis or because survival rates for the same stage differ. In some adult cancers, both reasons explain some of the observed survival differences between countries.
So far, it has not been possible to compare tumour stage at diagnosis or survival by stage for children’s cancers between countries. This is because measurement systems designed for adult cancers do not apply to children’s cancers and CRs often hold very little information on tumour stage. This project will help CRs use a new international system to measure stage in children’s cancers and make reliable comparisons of survival rates to understand any differences.
Prof. Kathy Pritchard-Jones, Dr Gemma Gatta and their international team will analyse patient data from >8,000 children across 26 countries, including the UK, Brazil, Canada, Australia, Japan and across Europe. They will focus their analysis on six different cancer types:
This project will provide the first ever standardised data on children’s tumour stage and survival and will allow meaningful comparisons in patient outcomes across Europe and other westernised countries. By understanding why childhood cancer survival rates still vary across Europe and other developed countries, Prof. Pritchard-Jones and her team could guide countries on how to improve childhood cancer survival rates in their own nations.
If the results show that in some countries children are more likely to have higher stage tumours at diagnosis, this suggests that national health service improvement efforts should focus on earlier diagnosis. If the results show differences in the chances of survival for the same tumour stage and type between countries, this suggests that countries should examine whether this is due to variations or delays in how patients are treated.
The project will also establish the framework for future international research to continue to monitor and understand why young patients’ survival varies between countries.
The project is led by a childhood cancer specialist, Prof. Kathy Pritchard-Jones, and cancer epidemiologist, Dr Gemma Gatta. They will coordinate the involvement of 40 cancer registries and clinical colleagues across Europe and further afield. The research team are international leaders in measuring survival rates for different cancers in childhood and comparing these between countries or regions. They have worked together for many years in several European projects in this area, including the European Joint Action on Rare Cancers (JARC) and the EUROCARE network and interact with the International Agency for Research on Cancer (IARC) and the European Network of Cancer Registries (ENCR).
Professor Kathy Pritchard-Jones is the President of the International Society of Paediatric Oncology (SIOP) from October 2019 to October 2022, a position that will help raise awareness of this project globally to ensure its success and emphasise its importance to the WHO Global Initiative on Childhood Cancer to measure success.