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The experience of a single Australian paediatric oncology unit. 1000 patients 1964-1987
G B McCowage1, M R Vowels, R Brown
1Department of Haematology and Oncology, Prince of Wales Children's Hospital, Randwick, NSW.
Insights
Childhood cancer survival has significantly improved, with five-year survival rates reaching 79% by the 1980s. While outcomes for leukemia and lymphoma improved, neuroblastoma and acute non-lymphoblastic leukemia require further research and new treatment strategies.
Area of Science:
- Paediatric Oncology
- Cancer Epidemiology
- Clinical Outcomes Research
Background:
- Childhood malignant diseases pose a significant health challenge.
- Long-term survival data is crucial for evaluating treatment efficacy in paediatric oncology.
Purpose of the Study:
- To assess survival rates for children diagnosed with cancer between 1964 and 1987.
- To analyze survival trends based on decade of diagnosis and specific cancer types in a paediatric oncology unit.
Main Methods:
- Retrospective review of patient records from a single paediatric oncology unit.
- Inclusion of 1000 patients with diverse malignancies, including acute lymphoblastic leukaemia (ALL), central nervous system (CNS) tumours, and various sarcomas.
- Analysis of survival data according to decade of diagnosis and diagnostic group.
Main Results:
- Ten-year survival increased from 15% in the 1960s to 64% in the 1980s (excluding CNS tumours).
- Five-year survival reached 79% from 1985 onwards.
- Significant survival improvements were observed for ALL, non-Hodgkin's lymphoma (NHL), and osteogenic sarcoma, while outcomes for neuroblastoma and ANLL remained poor.
Conclusions:
- Substantial progress in childhood cancer survival has been achieved over three decades.
- Current five-year survival is 79% (excluding CNS tumours), highlighting treatment advancements.
- Certain diagnostic groups, such as neuroblastoma and ANLL, necessitate novel therapeutic approaches.
Objective:
To determine the survival for children with malignant disease diagnosed in the period 1964-1987 and treated in a single paediatric oncology unit.
Design:
Records of patients treated by the Department of Haematology and Oncology at the Prince of Wales Children's Hospital were reviewed to determine the survival of children with cancer according to decade of diagnosis and diagnostic group.
Patients:
Patients were eligible for the study if referred for treatment at or soon after diagnosis of malignancy. One thousand patients were treated during the study period. There were 363 with acute lymphoblastic leukaemia (ALL), 126 with tumours of the central nervous system (CNS), 86 with acute non-lymphoblastic leukaemia (ANLL), 81 with lymphoma, 79 with neural crest tumours, 69 with renal tumours, 66 with bone sarcomas, 53 with soft tissue sarcomas, and 77 with various other diagnoses. Age range was one day to 20.75 years.
Interventions:
Treatment included surgery, radiotherapy and chemotherapy in a variety of protocols.
Results:
Ten-year survival for the 1960s, 1970s and 1980s was 15%, 51% and 64% respectively (P < 0.001), excluding tumours of the CNS. From 1985 onwards, actual survival at five years has been 79%. Survival from Wilms' tumour and Hodgkin's disease remained high throughout the study period, and significant improvement in survival occurred with ALL, non-Hodgkin's lymphoma (NHL) and osteogenic sarcoma. Survival remained poor with neuroblastoma and ANLL.
Conclusions:
Significant improvement in outcomes for childhood malignancy has been achieved over the last three decades, with five-year survival currently at 79% (excluding tumours of the CNS). Some diagnostic groups have had only small improvements in outcome and require new strategies.