Cancer Survival for Children in England- Patients Diagnosed: 1990-2006 and Followed up to 2011

• Five-year survival has gradually increased for children (aged 0–14 years) diagnosed with cancer from 66.6% in 1990 to 81.3% in 2006

• Increases in survival over this period have been slightly larger in those aged 5–9 years at diagnosis than in those aged 0–4 years or 10–14 years

• Five-year survival has consistently been above 80% for all childhood cancers combined since those diagnosed in 2004

This is the first statistical bulletin on childhood cancer survival in England. It was prompted by the recent introduction of an indicator on 5-year survival from all cancers in children aged under 15 years in the NHS Outcomes Framework for 2013–2014. The NHS Outcomes Framework was established to monitor overall changes in performance of the NHS and the quality of health outcomes.

This bulletin includes data on survival for all children (aged 0–14 years) diagnosed with cancer in England during 1990-2006, followed up to 31 December 2011 (see Background Note 1). Five-year survival estimates are presented for all cancers combined, for each year from 1990 to 2006 (see Background Note 2). Survival estimates are reported by age group and for all ages combined, both unstandardised and age-standardised (see Background Note 3).

Figure 1 shows smoothed five-year survival estimates for children diagnosed with cancer in England between 1990 and 2006, for age groups 0–4, 5–9, and 10–14 years, and age-standardised survival for all ages combined (see Background Note 4).

For all children (0–14 years) diagnosed with cancer in 2006 and followed up to the end of 2011, overall age-standardised five-year survival was 81.3% (Table 1 (105.5 Kb Excel sheet)). Five-year survival among those aged 5–9 years was 83.5%, slightly higher than for children aged 0–4 years (79.0%) or 10–14 years (81.3%).

For all childhood cancers combined, five-year survival has increased fairly steadily, from 66.6% for children diagnosed in 1990 to 81.3% for children diagnosed in 2006. This is an absolute increase of 14.7% over a 17-year period, or about 1% each year.

The increase of 17.0% in five-year survival for children aged 5–9 years at diagnosis was somewhat larger than the increases seen among children aged 0–4 years (12.5%) and children aged 10–14 years (14.6%).

Gradual increases in survival over the period 1990–2006 are likely to be a result of improvements in treatment and supportive care (Stiller, 2007). These increases occurred in parallel with improvements in outcomes reported by relevant clinical trials of treatments for childhood cancers (Stiller et al., 2012). The increase was slightly greater for those aged 5–9 years at diagnosis than for children who were younger or older at diagnosis. This is probably due to variation in the relative frequency of the different types of cancer with age. For example, the 5–9 years old age group contains relatively few cases of neuroblastoma (mainly found in younger children) and bone sarcoma (more frequent in older children), two types of cancer for which increases in survival have been relatively small.

More than half of all the childhood cancers diagnosed during the period 1990–2006 were leukaemias (32%) and malignant neoplasms of the brain and central nervous system (26%).

Detailed results are presented in Table 1 (105.5 Kb Excel sheet) in the associated data section of this publication.

Key users of cancer survival estimates include the Department of Health, academics and researchers, cancer charities, cancer registries, other government organisations, researchers within ONS, the media, and the general public. The Department of Health uses cancer survival figures to brief parliamentary ministers, and as part of the evidence base to inform cancer policy and programmes, for example in drives to improve survival rates. Cancer survival estimates will also be used to measure progress against NHS Outcomes Framework indicators. Academics and researchers use the figures to inform their own research. Similarly cancer registries and other government organisations use the figures to carry out individual and collaborative projects to apply subject knowledge to practice. Charities use the data so they can provide reliable and accessible information about cancer to a wide range of groups, including patients and health professionals via health awareness campaigns and cancer information leaflets/web pages. Researchers within ONS use the data to support further research and to publish alongside other National Statistics.

In ‘Improving Outcomes: A Strategy for Cancer’ (January 2011), the Department of Health stated that although improvements have been made in the quality of cancer services in England, a significant gap remains in survival compared with the European average. The strategy document sets out how the Department of Health aims to improve outcomes for all cancer patients and improve cancer survival, with the aim of saving an additional 5,000 lives every year by 2014/15.

Outcomes strategies set out how the NHS, public health and social care services will contribute to the ambitions for progress agreed with the Secretary of State in each of the high-level outcomes frameworks. The indicator set for the NHS Outcomes Framework 2013–2014 includes five-year survival from all cancers in children under 15 years. This indicator on childhood cancer survival has been introduced to the NHS Outcomes Framework for the first time in 2013–2014. Cancer is responsible for 21% of all deaths in children aged 1–14 and causes more death of children in this age group than any other cause, so an indicator for this group is clearly important.

Tsion Solomon^a, Sarah Whitehead^b, Michel P Coleman^a, Charles Stiller^c

Notes for authors

1. ^aCancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine

   ^bCancer Analysis Team, Office for National Statistics

   ^cChildhood Cancer Research Group, University of Oxford

The National Cancer Registry at the Office for National Statistics, the Childhood Cancer Research Group and the London School of Hygiene & Tropical Medicine wish to acknowledge the work of the regional cancer registries in England, which provided the raw data for these analyses.