The increase in survival of children and young people diagnosed with cancer has been astounding. In the 1970s in the UK, just 36% of children (aged 0-14 years) survived for 10 years beyond a cancer diagnosis. Now, it’s about eight in 10.
According to Laura Danielson, children’s and young people’s research lead at Cancer Research UK, cutting-edge research is the driving force behind this success. However, progress against different cancers is advancing at different rates. While about 99% of children diagnosed with retinoblastoma, a type of eye cancer, survive for at least five years, for those diagnosed with certain types of brain tumours, survival beyond five years remains very low, at less than 25%. And although around 90% of children diagnosed with the most common type of leukaemia will survive for more than five years, the prognosis for other forms of this type of cancer isn’t as good.
“When we talk about cancers in children and young people, we are referencing a very diverse group of 88 different types of tumours,” Danielson says. But the overall picture is optimistic: there are 12 sub-groups of cancers that affect children and young people, and all of these have seen an increased survival rate, she adds.
The advent and successful trialling and use of chemotherapy to treat children’s and young people’s cancers, particularly when done in combination, has a lot to do with this, Danielson says. But so too do huge advances in the scientific community’s understanding of the types of cancers found in this age group. She uses as an example the most common type of cancer experienced by children: leukaemia. “Almost a third of children in the UK diagnosed with cancer will have leukaemia,” she says. It is both the most common type of cancer in this age group and one of the types most children will end up surviving.
“Before the 1970s, the most common types of leukaemia were essentially considered a single disease,” she says, “and now we know that there are multiple different types. Within those different leukaemias, we have a better understanding of which ones may be higher risk … and we can actually see inside those cancer cells now, which helps to understand a child’s prognosis or the chances of their treatment working.”
This is gamechanging because it enables doctors to offer more individualised care to patients, which, in turn, can improve outcomes. “We can now have a much clearer picture of what type of cancer is occurring within the patient and are able to adjust the dose of chemotherapy offered, the stage at which it is offered and, in some cases, offer targeted therapy.” This all helps to maximise the likelihood that treatment will work.
“Research has been key to the huge success that we have seen in survival rates,” Danielson says. Cancer Research UK has played a significant role in that – particularly through the funding of large-scale clinical trials. But just looking at survival rates doesn’t show the whole picture, says Danielson. Many of the treatments that we credit for improving survival come with a cost. “Chemotherapy can be very effective at killing cancer cells, but can also cause a lot of damage to healthy tissues in the body. This can be particularly bad in children whose bodies are still developing, so many who survive their cancer are left with serious long-term side effects from the treatment.” This is why the advancement towards more targeted therapies and individualised care is so vital – not just to help more children survive but also for them to live a full life.
However, there are significant challenges that need to be overcome to keep progress moving forward. The fact that the incidence of cancer in children is so much lower than in adults (about 1% of all cancer cases in the UK are in under 25s) is one such challenge that makes research very difficult. “There are few samples available for researchers to study and test new drugs on, and it can be very difficult to run clinical trials,” Danielson says. “We have to form really strong collaborations – particularly across borders.” Because of this, she adds, some of Cancer Research UK’s biggest initiatives, as part of the organisation’s prioritisation of children’s and young people’s cancers, have all been done in partnership.
“One exciting collaboration came as part of our Cancer Grand Challenges [an initiative that Cancer Research UK co-founded in 2020 with the National Cancer Institute in America]. Cancer Grand Challenges supports a global community of interdisciplinary, world-class research teams to come together, think differently and take on some of cancer’s toughest challenges. In the last round, we invited applications to specifically develop new treatments for some of the hardest to treat tumours in children, and awarded £20m of funding, in partnership with The Mark Foundation, to the NexTGen team aiming to develop cutting-edge immunotherapies for children with solid tumours.”
According to Danielson, despite the huge progress in outcomes among the young, Cancer Research UK is more committed than ever to its aims within this clinical area. “By the end of today, on average 12 families up and down the country will have heard that their child, their brother or sister, their niece, grandson or cousin has cancer. Thankfully, because of research, most of them will survive. But we continue to fund more research to make sure they survive with a good quality of life. And then we also fund research to make sure that other families have hope where there currently is little.”
Ultimately, she says, it’s about making sure that every single child who’s diagnosed doesn’t just survive their cancer, but can live a long and healthy life. “And the key to that brighter future is research.”
This Childhood Cancer Awareness Month, find out more about cancers that affect children and young people, and Cancer Research UK’s work in this area at cruk.org/childrenandyoungpeople
