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Does diagnostic delay result in decreased survival in paediatric brain tumours?
Karel Kukal1, Milana Dobrovoljac, Eugen Boltshauser
1Department of Oncology, University Children's Hospital of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
Insights
Delays in diagnosing paediatric brain tumours did not impact survival outcomes. Tumour biology, not diagnostic timing, appears to be the primary factor influencing survival probability in children.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Research
Background:
- Delayed diagnosis in pediatric brain tumors is a concern.
- The impact of diagnostic delays on survival outcomes requires further investigation.
Purpose of the Study:
- To test the hypothesis that delayed diagnosis of pediatric brain tumors negatively affects survival.
- To analyze the relationship between prediagnostic intervals and survival in pediatric brain tumor patients.
Main Methods:
- Retrospective analysis of 315 pediatric brain tumor patients.
- Comparison of prediagnostic symptomatic interval, parental delay, and doctor's delay with progression-free and overall survival.
- Stratification of patients by tumor histology (low-grade glioma, medulloblastoma, high-grade glioma, craniopharyngioma, ependymoma, germ cell tumors).
Main Results:
- The median prediagnostic symptomatic interval was 60 days, with median parental and doctor delays of 14 days each.
- No significant correlation was found between extended prediagnostic intervals or doctor's delay and decreased survival outcomes across all patient groups.
- Prediagnostic interval correlated with patient age, tumor histology, location, and diagnosis year, but not gender.
Conclusions:
- Contrary to common assumptions, diagnostic delays do not appear to significantly reduce survival probability in pediatric brain tumors.
- Tumor biology is the dominant factor influencing survival, overshadowing the impact of diagnostic delays.
Abstract:
To study the hypothesis that a delay in the diagnosis of paediatric brain tumours results in decreased survival outcome probability, we compared the prediagnostic period of 315 brain tumour patients (median age 6.7 years, range, 0 to 16 years) with progression-free and overall survival. The median prediagnostic symptomatic interval was 60 days (range, 0 to 3,480 days), with a median parental delay of 14 days (range, 0 to 1,835 days) and a median doctor's delay of 14 days (range, 0 to 3,480 days). The prediagnostic symptomatic interval correlated significantly with the patient age, tumour histology, tumour location and year of diagnosis, but not with gender. We then grouped the patients according to histology (low-grade glioma [n=77], medulloblastoma [n=57], high-grade glioma [n=40], craniopharyngioma [n=27], ependymoma [n=20] and germ cell tumours [n=18]). Contrary to common belief, long prediagnostic symptomatic interval or long doctor's delay did not result in decreased survival outcome probability in any of these groups. The effect of tumour biology on survival seems to be dominant and overwhelms any possible opposing effect on survival of a delay in diagnosis.
