Presentation of childhood cancers to a paediatric shared care unit

Area of Science:

• Pediatric Oncology
• Cancer Diagnosis Pathways
• Health Services Research

Background:

• Understanding patient pathways is crucial for timely cancer diagnosis in children.
• Shared care oncology units play a role in managing pediatric cancer cases.
• Existing referral pathways may not be optimal for pediatric oncology.

Purpose of the Study:

• To delineate the diagnostic pathways for children with cancer presenting to a shared care oncology unit.
• To compare presentation and diagnosis timelines across different pediatric cancer types.
• To evaluate the effectiveness of the 2-week pathway in pediatric oncology.

Main Methods:

• A retrospective cohort study analyzed 93 children aged 0-15 diagnosed with cancer between 2004-2014.
• Patient pathways from initial symptoms to diagnosis were mapped.
• Time to presentation (TTP) and time to diagnosis (TTD) were calculated.

Main Results:

• Only 2.1% of cases utilized the 2-week pathway; most (67%) presented acutely via general practitioner referral or emergency department.
• Leukemia predominantly presented acutely via GPs, while solid tumors were more often self-referred to the emergency department.
• Wilms' tumor had the shortest median TTP (7 days) and TTD (16 days), whereas lymphoma had the longest TTD (120 days).

Conclusions:

• The majority of pediatric cancer diagnoses occur through acute services, with significant variation based on tumor type.
• The 2-week pathway appears infrequently used and potentially less relevant for pediatric cancer referrals.
• Optimizing referral pathways for pediatric oncology requires further investigation into acute presentation patterns.