Issues raised by the incidence and survival of childhood cancers
A partir de données de 198 registres des cancers de 53 pays portant sur 89 828 enfants âgés de moins de 14 ans et atteints d'une leucémie entre 1995 et 2009, cette étude analyse l'évolution de la survie, en fonction du sous-type de la maladie, de l'âge et du sexe du patient
An Article by Audrey Bonaventure and colleagues in the Lancet Haematology provides international comparisons of 5-year net survival statistics of children diagnosed with leukaemia, and another Article by Eva Steliarova-Foucher and colleagues in the Lancet Oncology is an exhaustive report on worldwide incidence rates of childhood cancers observed in 2001–10. Both are based on best-quality data from population-based cancer registries. The first Article by Bonaventure and colleagues documents the steady improvements in survival in children with leukaemia from 1995–2009. These improvements are essentially due to the combined effects of many factors including the increasing precision in diagnosis and the substantial progress in the management of children with cancer, including supportive care provided to children and their families. However, the accomplishment of 5-year net survival of around 80% in many high-income countries should not distract from the dire reality that about 80% of leukaemia cases in children occur in low-income and middle-income countries (LMICs) where there is little access to the sophisticated and costly specialised medical resources required for the optimum management of these conditions. From a worldwide perspective, it is the adoption by LMICS of affordable, locally adapted, multidisciplinary management programmes that is likely to translate into the largest gains in survival for children with haematological cancer.Steliarova-Foucher and colleagues rightly extend on the many challenges faced by the registration of childhood cancers. Nonetheless, I believe that cancer registries could further enhance research efforts intended to improve survival if they also captured the likely cause of death, or the health problems associated with the deaths. Knowing the causes of death might inform about whether children died from the cancer itself, or from a consequence of their management, or from another cause. This knowledge might help reveal associations between health problems, treatments, socioeconomic status, and other factors. Moreover, the causes of death might vary across countries, socioeconomic groups, and age groups. For instance, the type and frequency of infectious diseases affecting children with impaired immunity are expected to differ between tropical and temperate climates. Another example is the deaths of children who survive less than 1 month after cancer diagnosis, before therapies can change the disease course; these early deaths account for 7·5% of all childhood cancer deaths and their causes are still obscure. They particularly affect children with haematological cancer aged younger than 1 year who belong to deprived families, an observation that partly explains the poorer 5-year net survival of children aged younger than 1 year when the diagnosis of leukaemia is made.
The Lancet Haematology , commentaire, 2016