Highlights
- •Paediatric brain tumours are number one cause of oncology mortality.
- •Children in remote and rural locations have a significant delay to their diagnosis.
- •Significant delay from first presentation to medical imaging.
- •No delay from medical imaging to neurosurgical review and intervention.
- •No significant consequence to mortality but possible morbidity.
Abstract
Central nervous system tumours are the leading oncology cause of paediatric mortality.
The aim of this research was to identify stages within the diagnostic process of a
primary paediatric brain tumour that could be improved resulting in better outcomes.
Methods
The electronic medical records of Queensland Children’s Hospital patients with central
nervous system tumours between the 17/12/2014 till 11/12/2019 were retrospectively
accessed. Time intervals of symptom onset to first medical review, location, time till medical imaging, subspecialty or neurosurgical review, timing of surgery, diagnosis and mortality status
were recorded then analysed.
Results
A total of 168 patients were included. Mean age to 7.5, 65% male, with pilocytic astrocytoma
representing 31%. 71.4% of the population were from a major city as determined by
Remoteness Area classification, ABS, with 19% inner regional and 9.5% being outer
regional and remote. The average time from first medical review to diagnostic imaging
was significantly different when comparing remoteness classification (p = 0.044).
There was also a statistically significant difference in the duration of time from
medical imaging to specialist review comparing major city and outer regional/remote
(p = 0.016) and inner regional versus outer regional/remote areas (p = 0.026).
Conclusions
Delays in imaging in outer regional and remote Queensland are contributing to a delay
in diagnosis and intervention in paediatric brain tumours. Service provision for neurosurgery
in outer regional and remote Queensland is currently on par with inner regional and
city areas. Suspicion of paediatric brain tumours is needed with clear referral pathways
for general practitioners to access diagnostic imaging.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diagnostic delay and morbidity of central nervous system tumours in children and young adults: pediatric hospital experience.J Neurooncol. 2019; 143: 297-304
- Improving diagnosis of pediatric central nervous system tumours: aiming for early detection.CMAJ. 2017; 189: E459-E463
- Strategies to accelerate diagnosis of primary brain tumors at the primary-secondary care interface in children and adults.CNS Oncol. 2013; 2: 447-462https://doi.org/10.2217/cns.13.36. PMID: 25054667; PMCID: PMC6136128
- Be Brain Tumour Aware. A new clinical guideline from the Royal College of Paediatrics and Child Health with a national awareness campaign accelerates brain tumor diagnosis in UK children- “HeadSmart: Be Brain Tumour Aware”.Neuro-Oncology. 2015; 18: 445-454
- Delays in diagnosis of paediatric cancers: a systematic review and comparison with expert testimony in lawsuits.Lancet Oncol. 2012; 13: e445-e459https://doi.org/10.1016/S1470-2045(12)70361-3
- Duration between onset and diagnosis in central nervous system tumurs:impact on prognosis and functional outcome.Paediatr Int. 2014; 56: 829-833
Neal RD, Tharmanathan P, France B, Din NU, Cotton S, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer. 2015 Mar 31;112 Suppl 1(Suppl 1):S92-107. doi: 10.1038/bjc.2015.48. PMID: 25734382; PMCID: PMC4385982.
R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL http://www.R-project.org/. 2014.
- Specialist outreach to isolated and disadvantaged communities: a population-based study.Lancet. 2006; 368 (PMID: 16829297): 130-138https://doi.org/10.1016/S0140-6736(06)68812-0
Australian Bureau of Statistics (2016) ‘2016 Remoteness Area (RA) [https://dbr.abs.gov.au/absmaps/index.html]’ [interactive map], ABS Maps, last accessed 26 June 2021.
- Paediatric brain tumours treated at a single, tertiary paediatric neurosurgical referral centre from to 2010 in Australia.J Clin Neurosci. 1999; 2012: 1387-1391
- Cancer health inequality persists in regional and remote Australia.Med j Aust. 2014; 201: 445-446https://doi.org/10.5694/mja14.01217
Community Affairs Reference Committee. Availability and accessibility of diagnostic imaging equipment around Australia. March 2018. Commonwealth of Australia 2018. https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Diagnosticimaging/Report.
Article info
Publication history
Accepted:
March 5,
2022
Received:
September 26,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
