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Published on: December 19, 2017
Delay in the diagnosis of paediatric brain tumours: a systematic review
Kristy Kehoe1, Hansini Sivaguru2, Ian Coulter3
1Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK. Kristy.kehoe@nhs.net.
Insights
Delayed diagnosis in pediatric brain tumors does not appear to impact survival. This systematic review found no significant link between pre-diagnostic symptom interval and patient outcomes, highlighting diagnostic complexity.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Systematic Review Methodology
Background:
- Delayed diagnosis is linked to poorer outcomes in many cancers, but evidence in pediatric brain tumors is unclear.
- The pre-diagnostic symptom interval (PSI) is a critical metric for evaluating diagnostic delays.
- This study investigates the relationship between diagnostic delay and survival in pediatric brain tumors.
Approach:
- A systematic literature review was conducted following PRISMA guidelines.
- Searched MEDLINE, Wiley, Web of Science, and EMBASE for studies published between 2010 and 2022.
- Included studies focused on children and adolescents (<21 years) with new symptomatic primary brain tumors.
Key Points:
- Eleven studies were included in the narrative synthesis due to heterogeneity, precluding meta-analysis.
- The reported median PSI varied significantly, from 28 to 760.8 days.
- Tumor grade and patient age were the only factors consistently associated with prolonged PSI.
Conclusions:
- No significant association was found between a prolonged PSI and inferior overall survival in pediatric brain tumors.
- Confounding factors like tumor biology and inconsistent reporting obscure the impact of diagnostic delay.
- Diagnostic interval is a complex variable and should not overshadow clinical expertise and prompt diagnosis.
Purpose:
A delay in obtaining a diagnosis has been associated with inferior outcomes across several cancer types, including paediatric brain tumours. However, no clear evidence exists in this population. We aimed to quantify the reported pre-diagnostic symptom interval (PSI) as the time from onset of first symptoms to diagnosis in the literature, in addition to evaluating the relationship between delay and outcomes, including survival.
Methods:
A systematic review of the literature was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Wiley Online Library, Web of Science and EMBASE databases were searched. We considered all sources published between 1st January 2010 and 5th November 2022. Children and adolescents aged under 21 years, with new symptomatic primary brain tumour diagnoses, were included.
Results:
Of 3123 studies identified, 11 were included for analysis. Owing to study heterogeneity, a quantitative meta-analysis was not feasible; however, a narrative synthesis was performed. The median reported PSI varied widely, ranging between 28 and 760.8 days. We failed to identify a significant association between prolonged PSI and inferior overall survival. Few factors were consistently associated with prolonged PSI, amongst them only tumour grade and patient age.
Conclusion:
Delayed diagnosis of paediatric brain tumours was not associated with inferior survival within this review. This 'waiting time' paradox appears to result from several confounding factors including tumour biology, patient population and key systematic factors that were inconsistently reported. Diagnostic interval clearly presents a complex variable, reflected further by disparity in the reporting of delay within the literature. Ultimately diagnostic interval is unlikely to provide a meaningful representation for all tumour types and should not detract from sharp clinical acumen and prompt diagnosis.
