Adolescents with cancer in Italy: entry into the national cooperative paediatric oncology group AIEOP trials.

Purpose: Survival of adolescents (15-19 years old) with cancer has shown less favourable improvement in comparison with survival rates for younger children and older adults. This might be partly explained by the relative lack of participation of adolescents in cooperative clinical protocols.
Methods: This analysis compares the number of 15- to 19-year-olds treated at the paediatric oncology centres affiliated to the AIEOP (and registered in the 'model 1.01') with the number of incident cases predicted in Italy based on incidence rates from the Italian network of cancer registries (AIRTum).
Results: By 2006, over 22,000 cases had been registered in the model 1.01, and 1743 of these were adolescents. The ratio of observed/expected (O/E) cases of 15- to 19-year-olds was 0.10 (as opposed to 0.77 for the 0-14-year-old children), and this ratio increased from 0.05 to 0.18 over three successive study periods (1989-1994, 1995-2000 and 2001-2006). Sarcomas were the neoplasms with the highest O/E ratios, with 0.28 and 0.43 for osteosarcoma and Ewing sarcoma and 0.33 and 0.39 for rhabdomyosarcoma and other soft-tissue sarcomas, respectively. In the period 1989-2006, 55% of the adolescents registered (versus 69% of the children) were enrolled in formal national trials.
Conclusion: Our study confirms a lower referral of 15- to 19-year-old adolescents to paediatric oncology units and their under-representation in clinical trials, but we also observed a progressive improvement in this situation in recent years.