Scientists from the Princess Máxima Center for pediatric oncology and the Netherlands Comprehensive Cancer Organisation (IKNL) analyzed data from more than 14,000 patients under the age of 18 who were diagnosed with cancer between 1990 and 2015. Theirs is the first study on developments in childhood cancer survival and death rates at a national level in the Netherlands.
‘Encouraging, but a long way to go’
Dr. Henrike Karim-Kos, principal investigator at the Princess Máxima Center for pediatric oncology and IKNL, who led the study, says: ‘It’s encouraging to see that the survival of children with cancer is on the rise, but our analysis also shows that we still have a long way to go.’
Survival rates have risen by about 9 percentage points between 1990 and 2015, according to the study, published in the European Journal of Cancer and funded by the Children Cancer-free Foundation (KiKa). Between 2010-2015, the 5-year survival of children with cancer was 81%. In 2000-2009 this was 77% and in 1990-1999 it was still 72%. The 10-year survival rate of children with cancer rose to 78% in 2010-2015, up from 75% in 2000-2009 and 69% in 1990-1999.
Survival rose regardless of sex or age. The greatest progress was seen among young people aged 15-17. Between 1990-1999 and 2010-2015, their 5- and 10-year survival increased by respectively 13 and 11 percentage points: from 70% to 83%, and from 67% to 78%.
Developments in a higher gear
Prof. Rob Pieters, member of the Board of Directors of the Princess Máxima Center for pediatric oncology, pediatric oncologist and co-author of the study, says: ‘We owe the improvements in prognosis to developments in the diagnosis and treatment of childhood cancer. For example, by adapting the treatment to the type and severity of the tumor, better recognition of specific syndromes, and new chemotherapy and combination therapies.’
‘Since the opening of the Princess Máxima Center in 2018, we have seen that developments in healthcare and research have sped up significantly,’ continues Rob Pieters. ‘New, promising forms of immunotherapy have been developed, including CAR-T in leukemia and anti-GD2 in neuroblastoma. They have led to some children with very hard to treat forms of neuroblastoma and leukemia now being cancer free.’
In the new study, the researchers also note the benefits of concentrating pediatric cancer care. Between 2004-2013 a large proportion of children with cancer was already treated in a specialist pediatric cancer center. Since 2018, all children with cancer in the Netherlands are treated in the Princess Máxima Center. Pieters: ‘As a unique childhood cancer center in the Netherlands, we attract the kinds of studies and new treatments that offer a truly promising outlook for children with cancer. I hope and expect that we will now drive progress even faster for the 20-25% of children who do not yet survive, and realize even better chances of survival.’
The figures in the new study reveal that progress in prognosis was strongest in children with tumors in an advanced stage. The chances of five year survival rose markedly for children whose non-Hodgkin lymphoma was diagnosed at an advanced stage: from 68% to 93%. Five year survival rates increased from 18% to 41% in high-risk neuroblastoma, and from 16% to 36% in the bone tumor, Ewing sarcoma.
The notable progress is due to improved diagnosis and treatment. Partly as a result of these improvements, the study also reveals a decline in in death rates. The total number of childhood cancer deaths fell by 2% per year in the age group 0-19 years. Some 147 children and young people in the Netherlands died of cancer in 1990, compared with 76 in 2018.
Research into better treatments
But these advances did not apply to all types of childhood cancer to the same extent, the researchers found. Henrike Karim-Kos: ‘Especially for children with neuroblastoma, bone tumors or some brain tumors, much more improvement is needed. Research into better treatments for these diseases is an important priority for the Princess Máxima Center.’
Aside from survival, quality of life is central to mission of the Princess Máxima Center, Rob Pieters adds. ‘Increasingly many children with cancer are cured, often thanks to intense and demanding treatment. That’s why in addition to increasingly effective treatments, we are also working on reducing side effects in the short and long term.’
Frits Hirschstein, founder of KiKa, said: ‘This is a fantastic new milestone! The proof that more money for research yields more cure. An incredible incentive for KiKa to continue full throttle in the coming years to enable even more excellent research and thus to continue this trend, preferably at an accelerated pace. Everything indicates that this is feasible thanks to the positive experiences and results of the Princess Máxima Center. KiKa is happy and proud!’