Data from the UK.
At the turn of the century, the TDI in the UK ranked poorly compared to other countries. In response to that, a campaign called “HeadSmart: Be brain tumour aware” was established to raise awareness of symptoms and the importance of timely imaging. Within 7 years of implementation, the TDI dropped from 14.4 weeks to 6.7 weeks 14. The following paragraphs outline the studies conducted in the UK regarding most common symptoms and the diagnostic intervals of paediatric brain cancers.
A systematic analysis released in 2007 on the presentation of childhood Central nervous system CNS tumours concluded that the most common symptoms were headache (33%), nausea and vomiting (32%) and abnormal gait or coordination (27%.) 15. They concluded that the factors that affect signs and symptoms are age, tumour location and neurofibromatosis status. The most common sign or symptoms in Supratentorial tumours are Unspecified symptoms raised Intracranial Pressure (47%), Seizures (38%) and Papilledema (21%.) Nausea and Vomiting (75%), Headaches (67%) and Abnormal gait and coordination difficulties are the most common signs of Posterior fossa tumours. Most patients with Spinal cord tumours presented with Back pain (67%) and Abnormal gait and coordination difficulties (42%) and Spinal deformity (39%.) Brainstem tumours are more commonly presented with Abnormal gait and coordination difficulties (78%), Cranial nerve palsies (52%). For central tumours, the most common signs are Headaches (49%), Abnormal eye squint (21%) and Nausea and vomiting (19%.)
Another study in 2011 tracked the progression of first symptom until diagnosis of Paediatric Brain tumours 12. It concluded that between symptom onset and diagnosis, there is an increase in symptoms and signs from a median (range) of 1 to 6, with more than half of the patients developing visual abnormalities between symptom and diagnosis. Amongst 56 children, the most common behavioural abnormality observed is lethargy. Amongst 101 children, 81 visited their General Practitioner (GP) first, followed by 79 visiting a paediatrician, 29 first visited the Emergency Department, 24 went to an ophthalmologist and 15 children visited the optician.
A population-based analysis by HeadSmart released in 2019 investigated TDI of children with brain cancers in relation to tumour type, grade, location, and age 16. It studied a cohort of (n = 710) children, between the ages 0- 18, with the median diagnostic age of 6.6 years. Majority of the tumours were located at the cerebellum (35.5%), followed by central (31.7%), cerebral hemisphere (22.7%) and brainstem (10.1%.) More than one third of all tumours (33.5%) were Low-grade gliomas. The second most common being high – grade gliomas (9.1%) followed by Optic Pathway gliomas (5.2%.) Tumours located Centrally have the longest TDI with a median of 10.5 weeks, whereas tumours located in the Cerebellum have a median of TDI of 7.4 weeks. Tumours located in the Cerebral hemisphere and Brainstem have a median TDI of 6.7 and 5.4 weeks respectively. Low grade tumours have a higher median TDI (10.4) as compared to High grade tumours (6.0.) Craniopharyngiomas have the longest median TDI of 15.1 weeks followed by Low grade gliomas 11.9 weeks and Optic pathway gliomas 10.4 weeks 16.