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.