Clinical trial enrollment of children with cancer in Canada

Results for Leukemia Lymphomas CNS tumours Non-CNS tumours

On this page

• Over the years
• Child characteristics
• Across Canada
• Types of leukemia
• Reasons for non-enrollment

Approximately 300 children under 15 years old are diagnosed with a non-central nervous system (CNS) solid tumour in Canada every year (CYP-C Data Tool). Overall, 14% are enrolled in a clinical trial for their initial treatment.

Approximately 220 children under 15 years old are diagnosed with a central nervous system (CNS) tumour in Canada every year (CYP-C Data Tool). Overall, 7% are enrolled in a clinical trial for their initial treatment.

Approximately 100 children under 15 years old are diagnosed with lymphoma in Canada every year (CYP-C Data Tool). Overall, 13% are enrolled in a clinical trial for their initial treatment.

Approximately 295 children under 15 years old are diagnosed with leukemia in Canada every year (CYP-C Data Tool). Overall, 48% are enrolled in a clinical trial for their initial treatment.

Over the years

Overall, the proportion of children with leukemia enrolled in a clinical trial for initial treatment declined from 69% in 2001 to a low of 15% in 2019. However, there has been a visible increase in enrollment rates since then, reaching 45% in 2021.

Overall, the proportion of children with lymphoma enrolled in a clinical trial for initial treatment declined from a peak of 31% in 2006 to less than 5% in 2021 (data point suppressed).

Overall, the proportion of children with a CNS tumour enrolled in a clinical trial for initial treatment declined from a peak of 13% between 2005 to 2007 to 5% in 2021.

Overall, the proportion of children with a non-CNS solid tumour enrolled in a clinical trial for initial treatment declined from 27% in 2001 to 6% in 2021. Enrollment was lowest in 2016: 1% of children with a non-CNS solid tumour were enrolled.

Figure 1. Proportion Number of children with leukemia enrolled in a therapeutic clinical trial for initial treatment, Canada, 2001 to 2021

Figure 1: Text description

Notes

Data source: The Cancer in Young People in Canada Program

• To ensure confidentiality, counts were randomly rounded either up or down to a multiple of 5. If the rounded count is zero, this means the actual number of cancer cases is zero. If the number of children is between 1 and 4, the number is expressed as "Suppr." to indicate data suppression was applied.
• Data from the Centre hospitalier universitaire de Sherbrooke (CHUS) and the Saskatchewan Cancer Agency are not complete beyond 2015 and 2020, respectively.
• Given the relative rarity of some cancers, the proportions presented in this report should be interpreted with caution as it can be difficult to distinguish differences based on random fluctuation from true differences in the underlying proportion when the number of cases is small (e.g., fewer than 20 cases).

See the Technical Notes for more information.

Child characteristics

Among children with leukemia, the highest clinical trial enrollment is for those aged 1 to 9 years old.

Enrollment is similar for males and females, and children from urban and rural/remote areas. Enrollment is also similar across neighbourhood income quintiles and distance from treatment centres.

Among children with lymphoma, females have the highest clinical trial enrollment. Children from the lowest neighbourhood income quintile have lower enrollment compared to those from the middle to highest quintiles.

Enrollment is similar across all age groups, and for children from urban and rural/remote areas. Enrollment is also similar for children living near and far from treatment centres.

Enrollment is similar across sex, neighbourhood income, and distance from treatment centre. Enrollment is similar for children from urban and rural/remote areas.

Among children with a non-CNS solid tumour, the highest clinical trial enrollment is for those aged 1 to 4 years old. Enrollment is similar across sex, neighbourhood income quintile, distance from treatment centre, and urban or rural/remote areas.

Figure 2. Proportion Number of children with leukemia enrolled in a therapeutic clinical trial for initial treatment by age group sex neighbourhood income quintile urban or rural/remote distance from treatment centre , Canada, 2001 to 2021

Figure 2: Text description

Notes

Data source: The Cancer in Young People in Canada Program

• To ensure confidentiality, counts were randomly rounded either up or down to a multiple of 5. If the rounded count is zero, this means the actual number of cancer cases is zero. If the number of children is between 1 and 4, the number is expressed as "Suppr." to indicate data suppression was applied.
• Children with missing or invalid postal codes are excluded from the results of enrollment by distance from treatment centre, neighbourhood income quintile and urban or rural/remote.
• Data from the Centre hospitalier universitaire de Sherbrooke (CHUS) and the Saskatchewan Cancer Agency are not complete beyond 2015 and 2020, respectively.
• Given the relative rarity of some cancers, the proportions presented in this report should be interpreted with caution as it can be difficult to distinguish differences based on random fluctuation from true differences in the underlying proportion when the number of cases is small (e.g., fewer than 20 cases).

See the Technical Notes for more information.

Across Canada

Clinical trial enrollment for children with leukemia varies across Canada and is significantly higher in Quebec (62%) than British Columbia (44%), the Prairies (46%), Ontario (45%), and the Atlantic provinces (47%). Enrollment proportions in these other regions are similar to one another.

Clinical trial enrollment for children with lymphoma is significantly higher in Quebec (19%) than British Columbia (10%), Ontario (12%) and the Prairies (12%).

Clinical trial enrollment for children with a CNS tumour is significantly higher in Quebec (11%) than the Atlantic provinces (4%), the Prairies (6%) and Ontario (7%).

Clinical trial enrollment for children with a non-CNS solid tumour is significantly higher in Quebec (19%) than British Columbia (10%), the Prairies (13%) and Ontario (10%). Children in the Atlantic provinces (19%) have higher enrollment than children in Ontario.

Figure 3. Proportion Number of children with leukemia enrolled in a therapeutic clinical trial for initial treatment across Canada, 2001 to 2021

Figure 3: Text description

Notes

Data source: The Cancer in Young People in Canada Program

• To ensure confidentiality, counts were randomly rounded either up or down to a multiple of 5. If the rounded count is zero, this means the actual number of cancer cases is zero. If the number of children is between 1 and 4, the number is expressed as "Suppr." to indicate data suppression was applied.
• Atlantic provinces include New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador. The Prairies include Manitoba, Saskatchewan, and Alberta. The Territories include Yukon, Northwest Territories, and Nunavut.
• Data from the Territories are suppressed due to small or unstable counts.
• Data from the Centre hospitalier universitaire de Sherbrooke (CHUS) and the Saskatchewan Cancer Agency are not complete beyond 2015 and 2020, respectively.
• Given the relative rarity of some cancers, the proportions presented in this report should be interpreted with caution as it can be difficult to distinguish differences based on random fluctuation from true differences in the underlying proportion when the number of cases is small (e.g., fewer than 20 cases).

See the Technical Notes for more information.

Types of leukemia

Among children with leukemia, those diagnosed with lymphoid leukemias (including acute lymphoblastic leukemia) have the highest clinical trial enrollment. Children with leukemia other than lymphoid leukemia or acute myeloid leukemia have lower clinical trial enrollment (11%).

The highest clinical trial enrollment is for those with Hodgkin lymphoma. Children with Non-Hodgkin lymphoma also have higher enrollment compared to those with other lymphomas (i.e., miscellaneous lymphoreticular neoplasms and unspecified lymphomas).

Among children with a CNS tumour, the highest clinical trial enrollment is for those diagnosed with embryonal tumours (17%) and ependymomas (14%).

Among children with a non-CNS solid tumour, the highest clinical trial enrollment is for those diagnosed with rhabdomyosarcoma (23%) and Ewing sarcoma (22%). Children with other non-CNS solid tumours (6%) have lower enrollment compared to other cancer subtypes.

Figure 4. Proportion Number of children with leukemia enrolled in a therapeutic clinical trial for initial treatment by type of leukemia, Canada, 2001 to 2021

Figure 4: Text description

Notes

Data source: The Cancer in Young People in Canada Program

• To ensure confidentiality, counts were randomly rounded either up or down to a multiple of 5. If the rounded count is zero, this means the actual number of cancer cases is zero. If the number of children is between 1 and 4, the number is expressed as "Suppr." to indicate data suppression was applied.
• “Other leukemias” includes chronic myeloproliferative diseases, myelodysplastic syndrome and other myeloproliferative diseases, and unspecified/other specified leukemias.
• “Other lymphomas” includes miscellaneous lymphoreticular neoplasms and unspecified lymphomas. Non-Hodgkin lymphoma excludes Burkitt lymphoma.
• “Other CNS tumours” includes other gliomas (incl. oligodendrogliomas) and other specified intracranial and intraspinal neoplasms.
• “Other non-CNS solid tumours” includes: retinoblastoma, renal tumors (other than nephroblastoma), hepatic tumors (other than hepatoblastoma), malignant bone tumors (other than osteosarcomas and Ewing sarcoma), soft tissue and other extraosseous sarcomas (other than rhabdomyosarcomas), germ cell tumors, trophoblastic tumors and neoplasms of gonads, other malignant epithelial neoplasms and malignant melanomas and other and unspecified malignant neoplasms.
• Given the relative rarity of some cancers, the proportions presented in this report should be interpreted with caution as it can be difficult to distinguish differences based on random fluctuation from true differences in the underlying proportion when the number of cases is small (e.g., fewer than 20 cases).
• Data from the Centre hospitalier universitaire de Sherbrooke (CHUS) and the Saskatchewan Cancer Agency are not complete beyond 2015 and 2020, respectively.

See the Technical Notes for more information.

Reasons for non-enrollment

Overall, 62% of children with leukemia are not enrolled in clinical trials because no trial was available at the time of diagnosis at their treatment centre. However, it's important to note that these patients may still receive evidence-based standard of care, which is often similar to the standard therapy that would have been offered in the clinical trial.

The remaining reasons for non-enrollment include: (i) language barriers were present, (ii) a trial was available but the patient was not eligible to participate, (iii) a trial was available but the physician recommended another treatment plan, (iv) the patient or family did not pursue any therapy, (v) a trial was available and the patient was eligible, but the patient or family decided not to participate, or (vi) other reasons.

Overall, 70% of children with lymphoma are not enrolled in clinical trials because no trial was available at the time of diagnosis at their treatment centre. Children with Burkitt lymphoma are more likely to not enroll in a clinical trial because no trial was available (81%). However, it's important to note that these patients may still receive evidence-based standard of care, which is often similar to the standard therapy that would have been offered in the clinical trial.

The remaining reasons for non-enrollment include: (i) language barriers were present, (ii) a trial was available but the patient was not eligible to participate, (iii) a trial was available but the physician recommended another treatment plan, (iv) the patient or family did not pursue any therapy, (v) a trial was available and the patient was eligible, but the patient or family decided not to participate, or (vi) other reasons.

Overall, 50% of children with a CNS tumour are not enrolled in clinical trials because no trial was available at the time of diagnosis at their treatment centre.

Children with intracranial and intraspinal embryonal tumours (including medulloblastomas) are more likely to not enroll in a clinical trial because no trial was available (58%). However, it's important to note that these patients may still receive evidence-based standard of care, which is often similar to the standard therapy that would have been offered in the clinical trial. The remaining reasons for non-enrollment include: (i) language barriers were present, (ii) a trial was available but the patient was not eligible to participate, (iii) a trial was available but the physician recommended another treatment plan, (iv) the patient or family did not pursue any therapy, (v) a trial was available and the patient was eligible, but the patient or family decided not to participate, or (vi) other reasons.

Overall, 63% of children with a non-CNS solid tumour are not enrolled in clinical trials because no trial was available at the time of diagnosis at their treatment centre.

Children with Wilm’s tumour are more likely to not enroll in a clinical trial because no trial was available (75%) compared to those with neuroblastoma (63%) and other non-CNS solid tumours (53%). However, it's important to note that these patients may still receive evidence-based standard of care, which is often similar to the standard therapy that would have been offered in the clinical trial. The remaining reasons for non-enrollment include: (i) language barriers were present, (ii) a trial was available but the patient was not eligible to participate, (iii) a trial was available but the physician recommended another treatment plan, (iv) the patient or family did not pursue any therapy, (v) a trial was available and the patient was eligible, but the patient or family decided not to participate, or (vi) other reasons.

Figure 5. Proportion of children with leukemia not enrolled because no trial was available for initial treatment, Canada (excluding Ontario), 2001 to 2021

Figure 5: Text description

Notes

Data source: The Cancer in Young People in Canada Program

• To ensure confidentiality, counts were randomly rounded either up or down to a multiple of 5. If the rounded count is zero, this means the actual number of cancer cases is zero. If the number of children is between 1 and 4, the number is expressed as "Suppr." to indicate data suppression was applied.
• Children from Ontario and children receiving palliative care are excluded. Children with missing reasons are also excluded.
• “Other leukemias” includes chronic myeloproliferative diseases, myelodysplastic syndrome and other myeloproliferative diseases, and unspecified/other specified leukemias.
• “Other lymphomas” includes miscellaneous lymphoreticular neoplasms and unspecified lymphomas. Non-Hodgkin lymphoma excludes Burkitt lymphoma.
• “Other CNS tumours” includes other gliomas (incl. oligodendrogliomas) and other specified intracranial and intraspinal neoplasms.
• “Other non-CNS solid tumours” includes: retinoblastoma, renal tumors (other than nephroblastoma), hepatic tumors (other than hepatoblastoma), malignant bone tumors (other than osteosarcomas and Ewing sarcoma), soft tissue and other extraosseous sarcomas (other than rhabdomyosarcomas), germ cell tumors, trophoblastic tumors and neoplasms of gonads, other malignant epithelial neoplasms and malignant melanomas and other and unspecified malignant neoplasms.
• Data from the Centre hospitalier universitaire de Sherbrooke (CHUS) and the Saskatchewan Cancer Agency are not complete beyond 2015 and 2020, respectively.

See the Technical Notes for more information.

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Suggested Citation

Centre for Surveillance and Applied Research, Public Health Agency of Canada. Clinical Trial Enrollment of Children with Cancer in Canada. Health Infobase. Ottawa (ON): Public Health Agency of Canada, 2025.