Assessing the feasibility and validity of the Toronto Childhood Cancer Stage Guidelines: a population-based registry study

Article


Aitken, Joanne F., Youlden, Danny R., Moore, Andrew S., Baade, Peter D., Ward, Leisa J., Thursfield, Vicky J., Valery, Patricia C., Green, Adele C., Gupta, Sumit and Frazier, A. Lindsay. 2018. "Assessing the feasibility and validity of the Toronto Childhood Cancer Stage Guidelines: a population-based registry study." The Lancet Child & Adolescent Health. 2 (3), pp. 173-179. https://doi.org/10.1016/S2352-4642(18)30023-3
Article Title

Assessing the feasibility and validity of the Toronto Childhood Cancer Stage Guidelines: a population-based registry study

ERA Journal ID214314
Article CategoryArticle
AuthorsAitken, Joanne F. (Author), Youlden, Danny R. (Author), Moore, Andrew S. (Author), Baade, Peter D. (Author), Ward, Leisa J. (Author), Thursfield, Vicky J. (Author), Valery, Patricia C. (Author), Green, Adele C. (Author), Gupta, Sumit (Author) and Frazier, A. Lindsay (Author)
Journal TitleThe Lancet Child & Adolescent Health
Journal Citation2 (3), pp. 173-179
Number of Pages6
Year2018
PublisherThe Lancet Publishing Group
Place of PublicationUnited Kingdom
ISSN2352-4642
2352-4650
Digital Object Identifier (DOI)https://doi.org/10.1016/S2352-4642(18)30023-3
Web Address (URL)https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(18)30023-3/fulltext
Abstract

Background: Cancer stage at diagnosis is crucial for assessing global efforts to increase awareness of childhood cancer and improve outcomes. However, consistent information on childhood cancer stage is absent from population cancer registries worldwide. The Toronto Childhood Cancer Stage Guidelines, compiled through an international consensus process, were designed to provide a standard framework for collection of information on stage at diagnosis of childhood cancers. We aimed to assess the feasibility of implementing the Toronto Guidelines within a national population cancer registry. Methods: We did a population-based registry study using data from the Australian Childhood Cancer Registry and included data from children aged 0–14 years diagnosed between Jan 1, 2006, and Dec 31, 2010 with one of 16 childhood cancers listed in the Toronto Guidelines (acute lymphoblastic leukaemia, acute myeloid leukaemia, Hodgkin's lymphoma, non-Hodgkin lymphoma, neuroblastoma, Wilms' tumour, rhabdomyosarcoma, non-rhabdomyosarcoma soft tissue sarcoma, osteosarcoma, Ewing's sarcoma, retinoblastoma, hepatoblastoma, testicular cancer, ovarian cancer, medulloblastoma, and ependymoma). We extracted data from medical records, and assigned stage according to the Tier 1 criteria (basic) and Tier 2 criteria (more detailed, requiring data from cytology, imaging, and other diagnostic tests, where available) using computer algorithms derived from the Toronto Guidelines. Additionally, expert reviewers independently assigned Tier 2 stage to a random subsample of 160 cases (ten per malignancy type). Feasibility of the guidelines was assessed on the percentage of cases that could be staged, agreement between stage assigned by the algorithms and the expert reviewers, and the mean time (min) taken to collect the required data. Findings: We obtained data for 1412 eligible children. Stage could be assigned according to Tier 2 criteria for 1318 (93%) cases, ranging from 48 (84%) of 57 cases of non-rhabdomyosarcoma soft tissue sarcoma to 46 (100%) cases of hepatoblastoma. According to Tier 1 criteria, stage could be assigned for 1329 (94%) cases, ranging from 131 (87%) of 151 cases of acute myeloid leukaemia to 46 (100%) cases of hepatoblastoma. By contrast, stage at diagnosis was recorded by the treating physician for 555 (39%) of the 1412 cases. The computer algorithm assigned the same stage as did one or more independent expert reviewers in 155 (97%) of the 160 cases assessed. The mean time taken to review medical records and extract the required data was 18·0 min (SD 9·5 per case). Interpretation: The Toronto Guidelines provide a highly functional framework that can be used to assign cancer stage at diagnosis using data routinely available in medical records for most childhood cancers. Data on staging have the potential to inform interventions targeting improved diagnosis and survival. Funding: Cancer Australia.

Keywordschildhood cancer, stage at diagnosis, population cancer registry, Toronto Childhood Cancer Staging Guidelines, Australia
ANZSRC Field of Research 2020321199. Oncology and carcinogenesis not elsewhere classified
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Byline AffiliationsInstitute for Resilient Regions
Cancer Council Australia, Australia
University of Queensland
Cancer Council Queensland, Australia
Cancer Council of Victoria, Australia
QIMR Berghofer Medical Research Institute, Australia
Queensland Institute of Medical Research, Australia
Hospital for Sick Children, Canada
Dana-Farber Boston Children’s Cancer and Blood Disorders Center, United States
Institution of OriginUniversity of Southern Queensland
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A multilevel investigation of inequalities in clinical and psychosocial outcomes for women after breast cancer
Youl, Philippa H., Baade, Peter D., Aitken, Joanne F., Chambers, Suzanne K., Turrell, Gavin, Pyke, Christopher and Dunn, Jeffrey. 2011. "A multilevel investigation of inequalities in clinical and psychosocial outcomes for women after breast cancer." BMC Cancer. 11. https://doi.org/10.1186/1471-2407-11-415
The influence of high-intensity compared with moderate-intensity exercise training on cardiorespiratory fitness and body composition in colorectal cancer survivors: a randomised controlled trial
Devin, James L., Sax, Andrew T., Hughes, Gareth I., Jenkins, David G., Aitken, Joanne F., Chambers, Suzanne K., Dunn, Jeffrey C., Bolam, Kate A. and Skinner, Tina L.. 2016. "The influence of high-intensity compared with moderate-intensity exercise training on cardiorespiratory fitness and body composition in colorectal cancer survivors: a randomised controlled trial." Journal of Cancer Survivorship. 10 (3), pp. 467-479. https://doi.org/10.1007/s11764-015-0490-7
A five-year prospective study of quality of life after colorectal cancer
Chambers, Suzanne K., Meng, Xingqiong, Youl, Pip, Aitken, Joanne, Dunn, Jeff and Baade, Peter. 2012. "A five-year prospective study of quality of life after colorectal cancer." Quality of Life Research. 21 (9), pp. 1551-1564. https://doi.org/10.1007/s11136-011-0067-5
Epidemiology of prostate cancer in the Asia-Pacific region
Baade, Peter D., Youlden, Danny R., Cramb, Susanna M., Dunn, Jeff and Gardiner, Robert A.. 2013. "Epidemiology of prostate cancer in the Asia-Pacific region." Prostate International. 1 (2), pp. 47-58. https://doi.org/10.12954/PI.12014
A longitudinal study of post-traumatic growth and psychological distress in colorectal cancer survivors
Occhipinti, Stefano, Chambers, Suzanne K., Lepore, Stephen, Aitken, Joanne and Dunn, Jeff. 2015. "A longitudinal study of post-traumatic growth and psychological distress in colorectal cancer survivors." PLoS One. 10 (9). https://doi.org/10.1371/journal.pone.0139119
Location of residence and breast cancer stage: a SEER population-based analysis
Brandon, Lindsay, Youl, Pip, Baade, Peter, Whiteside, Eliza and Kimlin, Michael. 2015. "Location of residence and breast cancer stage: a SEER population-based analysis." The Breast Journal. 21 (6), pp. 693-695. https://doi.org/10.1111/tbj.12499
Diffuse Solar UV Radiation and Implications for Preventing Human Eye Damage
Parisi, Alfio, Green, Adele and Kimlin, Michael G.. 2001. "Diffuse Solar UV Radiation and Implications for Preventing Human Eye Damage." Photochemistry and Photobiology. 73 (2), pp. 135-139. https://doi.org/10.1562/0031-8655(2001)0730135DSURAI2.0.CO2
Lifetime ultraviolet exposure estimates for selected population groups in south east Queensland
Parisi, A. V., Meldrum, L. R., Wong, J. C. F., Aitken, J. and Fleming, R. A.. 1999. "Lifetime ultraviolet exposure estimates for selected population groups in south east Queensland." Physics in Medicine and Biology. 44 (12), pp. 2947-2953. https://doi.org/10.1088/0031-9155/44/12/307
Effect of childhood and adolescent ultraviolet exposures on cumulative exposure in south east Queensland schools
Parisi, A. V., Meldrum, L. R., Wong, J. C. F., Aitken, J. and Fleming, R. A.. 2000. "Effect of childhood and adolescent ultraviolet exposures on cumulative exposure in south east Queensland schools." Photodermatology, Photoimmunology and Photomedicine. 16 (1), pp. 19-24. https://doi.org/10.1034/j.1600-0781.2000.160106.x
Evaluation of differences in ultraviolet exposure during weekend and weekday activities
Parisi, A. V., Meldrum, L. R., Kimlin, M. G., Wong, J. C. F., Aitken, J. and Mainstone, J. S.. 2000. "Evaluation of differences in ultraviolet exposure during weekend and weekday activities." Physics in Medicine and Biology. 45 (8), pp. 2253-2262. https://doi.org/10.1088/0031-9155/45/8/314
Photosensitization of the sunscreen octyl-p-dimethylaminobenzoate by UVA in human melanocytes but not in keratinocytes
Xu, Chunxia, Green, Adele, Parisi, Alfio and Parsons, Peter G.. 2001. "Photosensitization of the sunscreen octyl-p-dimethylaminobenzoate by UVA in human melanocytes but not in keratinocytes." Photochemistry and Photobiology. 73 (6), pp. 600-604. https://doi.org/10.1562/0031-8655(2001)0730600POTSOP2.0.CO2