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Eur J Cancer. 2015 Nov;51(17):2665-77. doi: 10.1016/j.ejca.2015.08.018. Epub 2015 Sep 3.

Childhood central nervous system tumour mortality and survival in Southern and Eastern Europe (1983-2014): Gaps persist across 14 cancer registries.

Author information

1
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
2
National Cancer Registry of Ukraine, National Institute of Cancer, Kyiv, Ukraine.
3
Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Childhood Cancer Subregistry of Belarus, Minsk, Belarus.
4
Bulgarian National Cancer Registry, National Oncology Hospital, Sofia, Bulgaria.
5
Institute of Public Health of Serbia, Belgrade, Serbia.
6
Izmir Cancer Registry, Izmir Hub, Izmir & Hacettepe University Institute of Public Health, Ankara, Turkey.
7
North Region Cancer Registry of Portugal (NORTH), Portuguese Oncology Institute of Porto, Portugal.
8
Croatian National Cancer Registry, Croatian Institute of Public Health, Zagreb, Croatia.
9
Cancer Registry of Republic of Slovenia, Institute of Oncology, Ljubljana, Slovenia.
10
Registo Oncológico Regional do Centro, Instituto Português de Oncologia de Coimbra Francisco Gentil E.P.E, Coimbra, Portugal.
11
Cyprus Cancer Registry-Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus.
12
Malta National Cancer Registry, Department of Health Information and Research, Malta.
13
Epidemiology, Institute of Public Health, 16-18 Victor Babes Street, Timisoara 300226, Romania.
14
Regional Cancer Registry of Cluj, Oncological Institute "Ion Chiricuta", Cluj-Napoca, Romania.
15
Oncology Department, "Mitera" Childrens Hospital, Erythrou Stavrou 6 Marousi, Athens, Greece.
16
2nd Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece.
17
Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki, Greece.
18
Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece.
19
Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Athens, Greece.
20
Department of Pediatric Hematology-Oncology, University of Crete, University Hospital of Heraklion, Heraklion, Greece.
21
First Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece.
22
Department of Neurosurgery, University Hospital of Heraklion, Heraklion, Crete, Greece.
23
Department of Neurosurgery, G. Gennimatas General Hospital, Athens, Greece.
24
Department of Pathology, Hygeia Hospital, Athens, Greece.
25
2nd Department of Radiology, Radiotherapy Unit, Medical School, National Kapodistrian University of Athens, Athens, Greece.
26
Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
27
Department of Neurosurgery, "Mitera" Childrens Hospital, Erythrou Stavrou 6 Marousi, Athens, Greece.
28
Department of Neurosurgery, St. Luke's Hospital, Panorama, Thessaloniki.
29
Haematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece.
30
Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
31
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece. Electronic address: epetrid@med.uoa.gr.

Abstract

AIM:

Childhood central nervous system (CNS) tumour registration and control programs in Southern and Eastern Europe remain thin, despite the lethal nature of the disease. Mortality/survival data were assembled to estimate the burden of malignant CNS tumours, as well as the potential role of sociodemographic survival determinants across 14 cancer registries of this region.

METHODS:

Average age-adjusted mortality rates were calculated, whereas time trends were quantified through Poisson and Joinpoint regressions. Kaplan-Meier curves were derived for the maximum and the more recent (10 and 5 year) registration periods. Multivariate Cox regression models were used to assess demographic and disease-related determinants.

RESULTS:

Variations in mortality (8-16 per million) and survival (5-year: 35-69%) were substantial among the participating registries; in most registries mortality trend was stable, whereas Bulgaria, having the highest starting rate, experienced decreasing annual mortality (-2.4%, p=0.001). A steep decrease in survival rates was evident before the second year of follow-up. After controlling for diagnostic subgroup, age, gender and diagnostic year, Greece seemed to present higher survival compared with the other contributing registries, although the follow-up period was short. Irrespective of country, however, rural residence was found to impose substantial adverse repercussions on survival (hazard ratio (HR): 1.2, 95% confidence interval (CI): 1.1-1.4).

CONCLUSION:

Cross-country mortality and survival variations possibly reflect suboptimal levels of health care delivery and cancer control in some regions of Southern and Eastern Europe, notwithstanding questionable death certification patterns or follow-up procedures. Continuous childhood cancer registration and linkage with clinical data are prerequisite for the reduction of survival inequalities across Europe.

KEYWORDS:

Cancer registries; Central Nervous System tumours; Child; Disparities; Economic status; Health care delivery; Mortality; Survival; Urbanisation

PMID:
26343313
DOI:
10.1016/j.ejca.2015.08.018
[Indexed for MEDLINE]

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