Although there have been improvements in 5-year cancer survival in children and in adolescents and young adults (AYAs) during recent years, a large analysis of European registry data shows that AYAs are at greater mortality risk than children for several common cancers.
Analyzing data on more than 350,000 cancer cases in children and AYAs in 27 European countries, the researchers found that 5-year survival was better among AYAs than among children. By 2007, survival rates had improved to 82% and 79%, respectively.
However, the study revealed that AYAs had significantly worse survival than children for eight relatively common cancers, particularly blood cancers, such as leukemias and non-Hodgkin's lymphoma.
The research was published online May 26 in the Lancet Oncology.
Lead author Annalisa Trama, PhD, at the Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy, said in a statement that although the good news is that survival has improved across all cancers, "we found that adolescents and young adults still tend to die earlier than children for several cancers common to these age groups."
It is noteworthy that the study period (1999-2007) of the current analysis predates several initiatives that were undertaken recently in several European countries to improve survival among AYAs.
Dr Trama commented: "The European Network for Teenagers and Young Adults With Cancer is advocating collaboration between pediatric and adult oncologists, greater access to clinical trials, and research to improve treatments for this specific age group, as well as developing adolescent and young adult–specific practice guidelines, encouraging healthier lifestyles, and the greater involvement of patients and patients support groups.
"This study will provide an important starting point from which to evaluate whether these initiatives will reduce the gulf in survival between European adolescents and young adults and children with cancer."
Details of the Findings
The researchers compared 5-year survival rates for AYAs, classified according to the latest definition as individuals aged 15 to 39 years, to survival rates reported for children (patients younger than 15 years) and adults (patients aged 40 to 69 years).
The team analyzed data from the population-based cancer registries of 27 European countries taking part in the EUROCARE-5 study.
They determined population-weighted 5-year survival rates relative to the general population for 19 cancers that affect both AYAs and children and for 27 cancers that affect AYAs and adults. They also assessed changes in survival between 1999 and 2007.The researchers analyzed survival rates for 56,505 cancers diagnosed in children, 312,483 cancers in AYAs, and 3,567,383 cancers in adults. The population-weight and case mix–adjusted relative 5-year survival rates for all cancers combined in children and AYAs were 76% and 79%, respectively.
Female AYAs had overall better survival than male AYAs; among children, there was no difference in survival between the sexes. Survival improved during the study period in both children and AYAs, increasing from 79% to 82% between 1999-2002 and 2005-2007 in AYAs and from 76% to 79% during the same period in children.
The improved 5-year survival in AYAs compared with children was largely due to AYAs being more likely to be diagnosed with cancers associated with good prognoses, such as Hodgkin's lymphoma, non-Hodgkin's lymphoma, germ cell tumors, melanoma, thyroid carcinoma, and breast carcinoma. The overall prevalence was 57% for AYAs and 15% for children.
Nevertheless, 5-year relative survival rates were significantly worse in AYAs than in children for eight common cancers in those age groups, at 55.6% vs 85.8% for acute lymphoid leukemias, 49.8% vs 60.5% for acute myeloid leukemias, 92.9% vs 95.1% for Hodgkin's lymphoma, 77.4% vs 83.0% for non-Hodgkin’s lymphoma, 46.4% vs 61.9% for astrocytomas, 49.3% vs 66.6% for Ewing's sarcoma, 37.8% vs 66.6% for rhabdomyosarcoma, and 61.5% vs 66.8% for osteosarcoma (for osteosarcoma, P = .011; for all others, P < .0001).
During the study period, 5-year survival improved significantly in both children and AYAs for acute myeloid leukemia (P < .0001 in both AYAs and children) and non-Hodgkin lymphoma (P < .0001 in AYAs; P = .023 in children). Survival improved significantly in AYAs for central nervous system tumors (P = .0046), astrocytomas (P = .040), and malignant melanomas (P < .0001).
Overall, for the majority of cancers, 5-year survival rates among AYAs were better than among adults. There were some notable exceptions to this. No significant difference in survival rates were seen in colorectal cancer (P = .49), and AYAs had significantly worse survival rates for breast cancer, at 83.5% vs 87.0% (P < .0001) and prostate cancer, at 79.9% vs 89.8% (P < .0001).
The authors note that one of the strengths of their study "was that we evaluated outcomes in a large population-based database of child, AYA, and adult cancer cases archived by European cancer registries.
"In the future, data provided by these registries will be vital to assess whether changes in management policies have the desired effect to improve survival in European AYAs who develop cancer."
In an accompanying editorial, Philippe Autier, MD, University of Strathclyde Institute of Global Public Health at the International Prevention Research Institute, Lyon, France, highlighted the fact that more information was needed on the causes of death in AYAs "to improve patient management.
"At a clinical level, assessing the causes of death occurring during the relative survival follow-up might provide information on whether patients died from the cancer itself, from disease management, or from another cause," he writes.
"Knowledge of causes of death might help to unveil associations between cancers, treatments, socioeconomic factors, quality of life, and causes of death.
"To this end...the identification and characterisation of health events possibly associated with cancer therapies in adolescents and young adults should be carried out, with training for assessors of cause of death in the use of the list of identified health events," Dr Autier concludes.
The study received funding from the Italian Ministry of Health and the European Commission. The study authors and Dr Autier have disclosed no relevant financial relatinships.
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