Children and young people with cancer face several unique challenges.

Quality care and early diagnosis increase the chance of survival

Not all children with cancer in Europe have equal access to standard care, expertise, and research. Compared to other European regions, five-year survival is 10-20% lower in Eastern Europe – and this gap may be even larger in countries where cancer survival is not measured at a population level. The majority of these disparities are due to the different treatment approaches, the organisation of care, and the availability of resources across Europe.

Early diagnosis of childhood cancer through large national programs (such as for adult cancers) is difficult to achieve. Childhood cancers grow relatively rapidly, and although lifestyle and environmental factors are partially responsible for this, most cancers in younger children are not strongly influenced by the major risk factors associated with the onset of certain cancers at older ages, such as tobacco, alcohol, or nutrition. With the exception of the likely infectious origin of lymphoma at young ages, relatively few causal factors have been identified so far. There is therefore a need to better understand the causes and external risk factors of paediatric cancers in order to address prevention in younger age groups wherever possible.

Early diagnosis currently depends on early recognition and timely referral by primary care providers. A long delay between the first symptoms and diagnosis of cancer delays initiation for treatment and may jeopardise patient outcome. Therefore, it is crucial that primary care providers, like general practitioners and primary care paediatricians, are trained adequately. Unfortunately, paediatric training is currently not a mandatory part of general practitioner  training, nor is paediatric oncology recognised as a subspecialty in most European countries.

Unmet treatment needs

Little progress has been made in the treatment of difficult-to-treat diseases, like acute myeloid leukaemia, several brain tumours, and extremely rare tumours. Innovative treatments with new mechanisms of action are required and need to be introduced into standard care.  Although the EU Paediatric Medicine Regulation has changed the landscape of drug development for childhood cancer considerably, access to new medicines need significant  improvement. Basic research (in laboratories) and clinical research (in humans) need to become more integrated to make cancer research more efficient and focused.

Globally and in Europe, adolescents and young adults with cancer have lower survival rates than younger children and their specific needs are not always addressed. Cancers in young people range from childhood cancers (like leukaemia and lymphoma) to cancers occurring more often in adults (like cervical cancer and melanoma). Incidence rates of cancers linked to obesity are increasing most rapidly in young adults, meaning that the future burden of cancer in this age group could halt or even reverse the progress that has been achieved in terms of lowering cancer mortality. Targeted surveillance, prevention, and treatment are crucial to reduce the cancer burden in this underserved age group.

Survivors

There are more than 300,000 European childhood cancer survivors, a figure that is expected to reach nearly half a million by the year 2020. Two-thirds of survivors experience late side effects of treatment which can be severe and impact daily life. As such,  increasing the quality of survivorship, developing treatments with lowered side effects, and ensuring a balanced transition to adult oncology services for further follow-up are three critical priorities.