Cancer Stage Geospatial Analysis to Optimize Educational Activities in Pediatric Oncology and Hematology: A Retrospective Cohort Study.

Abstract

Background: Enhancing therapy outcomes in pediatric oncology and hematology relies on robust epidemiological surveillance. This study aimed to estimate cancer stage-related survival in pediatric patients with lymphoma and solid tumors by assessing changes over time and identifying spatial clustering of patients diagnosed at advanced stages.

Procedure: This retrospective observational cohort study included pediatric cancer patients treated in a single Greater Poland center, constituting 9% of Polish children from 2004 to 2017. The incidence, cancer stage, and patient coordinates were analyzed. The follow-up period ranged from 5 to 18 years. Survival differences across tumor stages were evaluated using Kaplan‒Meier curves, log-rank tests, and trend analysis. Geographical analysis was performed with Kulldorff's scan statistics and the Bernoulli model.

Results: Among 1094 diagnosed patients, 511 with lymphoma and solid tumors were eligible. There was a decreasing trend in advanced-stage diagnoses (p = 0.0001), with a nearly twofold increase in low-stage diagnoses (OR = 1.98 [1.22; 3.24], p = 0.0061) from 2009-2011 to 2015-2017. Hazard ratios for neuroblastoma and sarcoma patients were more than fourfold greater, while survival differences were not significant for patients with nephroblastoma, germ cell tumors, or lymphoma.

Conclusions: This study shows cancer stage-related survival dynamics. A substantial decrease in advanced-stage diagnoses over time emphasizes improved early detection. Geographical analysis pinpointed clusters with prevalent late-stage diagnoses, offering a practical tool for targeted educational interventions. The study underscores the pivotal impact of cancer stage on survival outcomes, emphasizing the need for ongoing surveillance and tailored interventions to further optimize pediatric oncology and hematology care.