Childhood cancer: Patterns of protocol participation in a national survey

Cancer is still the chief cause of death by disease in children, ages one t o 14. As improved survival rates have been reported for pediatric cancer pa tients who are treated on controlled clinical trials, it is important to un derstand the national utilization of such protocols. In 1993, a survey of childhood cancer was conducted by the Commission on Ca ncer of the American College of Surgeons. Data regarding type of disease, p rotocol participation, age, sex, race, insurance, and geographical region w ere voluntarily submitted by more than 200 hospital cancer registries. Incl uded in this study were 2,208 children and adolescents 21 years of age or y ounger who were diagnosed in 1987, and 2,293 who were diagnosed in 1992. Pe diatric centers (i.e., members of the Pediatric Oncology Group or Children' s Cancer Group) submitted 55.1% of the cases and other institutions, 44.9%. It was found that more patients treated at pediatric centers were on protoc ols (53.8%) than were those treated at other institutions (25.1%). In gener al, the younger the patient (five years of age or younger), the greater the chance of being on protocol (pediatric centers, 63.7%; others, 42.0%), wit h very poor adolescent protocol participation (pediatric centers, 34.8%; ot hers, 12.1%). Nevertheless, overall protocol participation was still lower than expected, even in children younger than five years of age, and adolesc ent participation in controlled clinical trials was low and similar to adul t figures. The percentage of childhood cancer cases seen at pediatric cente rs was smaller than in other series. it was concluded that pediatric cancer centers need to continue to encourage patient participation in controlled clinical trials, with special emphasis on adolescents.