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Diagnostic Delay and Survival in Pediatric Rhabdomyosarcoma: Is Time a Critical Factor?
Maria C Affinita1, Stefano Chiaravalli2, Giuseppe M Milano3
1Pediatric Hematology, Oncology and Stem Cell Transplant Division Padua University Hospital, Padua, Italy.
Insights
Diagnosis times for pediatric rhabdomyosarcoma (RMS) have shortened, but this improvement does not significantly impact tumor characteristics or patient survival outcomes. Early diagnosis offers clarity but doesn't alter prognosis.
Area of Science:
- Pediatric Oncology
- Cancer Research
- Clinical Epidemiology
Background:
- Timely diagnosis is crucial in pediatric oncology for optimizing treatment outcomes.
- Delays in diagnosis for pediatric rhabdomyosarcoma (RMS) may negatively affect tumor extension and prognosis.
- Assessing trends in diagnostic and treatment intervals for RMS is important for improving patient care.
Purpose of the Study:
- To evaluate if the time to diagnosis and treatment initiation for pediatric RMS patients in Italy has improved over time.
- To determine if longer diagnostic delays are associated with tumor characteristics and prognosis in pediatric RMS.
- To analyze the impact of diagnostic and treatment intervals on survival outcomes for children with RMS.
Main Methods:
- Analysis of 749 pediatric patients diagnosed with RMS between 1996 and 2016.
- Definition of diagnostic interval (DI) as symptom onset to diagnosis, and treatment interval (TI) as symptom onset to treatment initiation.
- Correlation of DI with tumor characteristics and analysis of TI in relation to survival using Kaplan-Meier analysis.
Main Results:
- Median DI decreased from 39.5 days (1996-2000) to 30 days (2011-2016).
- Longer DI was associated with age, unfavorable histology, and metastatic disease in univariate analysis, but not confirmed in multivariate analysis.
- Prognosis was negatively associated with age, unfavorable site, nodal involvement, and metastatic disease; TI did not impact survival.
Conclusions:
- The time from symptom onset to diagnosis for pediatric RMS shows a trend toward shortening in recent years.
- While timely diagnosis provides clarity and may reduce parental anxiety, it does not substantially impact tumor characteristics or patient outcomes.
- Factors like age at diagnosis, tumor site, nodal involvement, and metastatic disease are key prognostic indicators in pediatric RMS.
Background:
Timely diagnosis is considered critical in pediatric oncology to optimize treatment outcomes, as delays may impact tumor extension and prognosis. We aimed to assess whether the time to diagnosis and treatment initiation for pediatric patients with rhabdomyosarcoma (RMS) improved over time in Italy and whether longer delays were associated with tumor extension and prognosis.
Methods:
We analyzed 749 pediatric patients diagnosed with RMS between 1996 and 2016. Diagnostic interval (DI) was defined as the number of days from symptom onset to diagnosis, while treatment interval (TI) was defined as the time from symptom onset to treatment initiation. DI was correlated with tumor characteristics at diagnosis, and TI was analyzed in relation to survival, using Kaplan-Meier analysis.
Results:
The median DI was 32 days, showing a decreasing trend from 39.5 days in 1996 to 2000 to 30 days in 2011 to 2016. A longer DI was associated with age, unfavorable histology, and metastatic disease in univariate analysis, but these were not confirmed in multivariate analysis. The median TI was 48 days. Five-year event-free survival (EFS) and overall survival (OS) were 59.7% and 69.3%. In multivariate analysis, prognosis was negatively associated with age at diagnosis, unfavorable site, nodal involvement, and metastatic disease. TI was not associated with survival.
Conclusions:
In our national cohort, the time from symptom onset to diagnosis showed a trend toward shortening in recent years. While a timely diagnosis can provide clarity on the child's condition and potentially reduce parental anxiety, it does not substantially impact tumor characteristics or patient outcomes.
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