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Weile KS, Helligsoe ASL, von Holstein SL, Winther JF, Mathiasen R, Hasle H, Henriksen LT. Patient- and parent-reported diagnostic delay in children with central nervous system tumors in Denmark. Pediatr Blood Cancer 2024:e31128. [PMID: 38814259 DOI: 10.1002/pbc.31128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/01/2024] [Accepted: 05/18/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Diagnostic delays in childhood tumors of the central nervous system (CNS) pose a significant challenge. The aim of this study was to map diagnostic delay and presenting symptoms in Denmark. METHODS The study was a retrospective questionnaire study, mapping delay and symptoms in pediatric patients (0-17 years), diagnosed with a CNS tumor from 2015 to 2019. Descriptive analysis was performed to measure delay in days, reported as total diagnostic interval (TDI), patient interval (PI), and diagnostic interval (DI). Analysis of symptoms, contacts to healthcare professionals, and socioeconomic status was also performed. RESULTS We included 89 patients (median age 7.0 years, 54% male). The TDI was median of 106 days (range: 0-2694 days). Low-grade tumors had longer TDI than high-grade tumors (125 vs. 43 days; p ≤ .02). Patients aged 15-17 displayed the longest TDI (median 665 days). Number of symptoms at onset were inversely associated with longer TDI in patients presenting one symptom (247 days) and patients presenting two to three (110 days) or greater than three complaints (66 days). PI was not associated with sex (p = .14), tumor grade (p = .63), location (p = .32), or socioeconomic status (p = .82). Most frequent single complaint at onset was headache (19%), most frequent combination of symptoms was headache and vomiting (60%). CONCLUSION We found TDIs longer than reported in contemporary publications. TDI was longer in patients with low-grade tumors and only few symptoms at the time of onset. The findings support the crucial need of awareness and improved diagnostic tools to recognize and interpret symptoms to promote timely diagnosis.
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Affiliation(s)
- Kathrine Synne Weile
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
| | - Anne Sophie Lind Helligsoe
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
| | - Sarah Linea von Holstein
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
- Danish Cancer Institute, Copenhagen, Denmark
| | - René Mathiasen
- Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
| | - Louise Tram Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
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2
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Tong T, Chen H, Mo C, Zhong L. Clinical characteristics and predictive factors of delayed diagnosis in patients with sellar germ cell tumors. J Neurooncol 2024; 167:467-476. [PMID: 38438767 DOI: 10.1007/s11060-024-04626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/28/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE To investigate the clinical characteristics and predictive factors associated with delayed diagnosis in patients with sellar germ cell tumors (GCTs), aiming for early diagnosis. METHODS A total of 345 patients with sellar GCTs were retrospectively collected. Patients were classified into a delayed diagnosis group (> 6 months from onset to diagnosis) and a non-delayed diagnosis group (≤ 6 months). We compared general characteristics, clinical symptoms, diagnostic methods, treatment strategies, tumor prognosis, and pituitary function between the two groups. Predictive factors for delayed diagnosis were explored using multivariate logistic regression analysis. RESULTS 225 patients (65.2%) experienced delayed diagnosis. Although there was no association between delayed diagnosis and survival rates or tumor recurrence rates, the delayed diagnosis group had a higher incidence of central diabetes insipidus, central adrenal insufficiency, central hypothyroidism, central hypogonadism, and growth hormone deficiency. Moreover, polyuria/polydipsia (OR 5.46; 95% CI 2.33-12.81), slow growth (OR 5.86; 95% CI 2.61-13.14), amenorrhea (OR 6.82; 95% CI 2.68-17.37), and germinoma (OR 4.99; 95% CI 1.08-3.61) were associated with a higher risk of delayed diagnosis, while older age of onset (OR 0.88; 95% CI 0.84-0.94) and nausea/vomiting (OR 0.31; 95% CI 0.15-0.63) contributed to earlier diagnosis. CONCLUSION In patients with sellar GCTs, delayed diagnosis is common and linked to increased pituitary dysfunction. The initial symptoms of slow growth, polyuria/polydipsia, and amenorrhea, as well as germinoma with negative tumor markers, predict the possibility of a delayed diagnosis. Early diagnosis is crucial to minimize the impact of sellar GCTs on pituitary function.
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Affiliation(s)
- Tao Tong
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring Road West, 100071, Beijing, China
| | - Han Chen
- Department of Geriatrics, Beijing Jishuitan Hospital, Capital Medical University, 100035, Beijing, China
| | - Caiyan Mo
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring Road West, 100071, Beijing, China
| | - Liyong Zhong
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring Road West, 100071, Beijing, China.
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3
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Turanzas NJ, Mathiasen R, Heegaard S, Schmiegelow K, Sehested A, Holtz JK, Siersma V, Nissen KR, von Holstein SL. Ophthalmic symptoms, clinical signs and diagnostic delay in infants diagnosed with brain tumours in Denmark between 2007 and 2017. Acta Ophthalmol 2024; 102:334-341. [PMID: 37574657 DOI: 10.1111/aos.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/21/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE To investigate ophthalmic onset manifestations and the impact of diagnostic delay on the prognosis in infants (<1 year) diagnosed with a brain tumour. METHODS A retrospective population-based nationwide study of infants diagnosed with a brain tumour between 2007 and 2017 in Denmark. Data was retrieved from the Danish Childhood Cancer Registry, the National Danish Health registries, and medical files. Primary outcome measures included symptoms, clinical findings, time to diagnosis and survival. RESULTS Thirty-seven infants were diagnosed with a brain tumour in Denmark between 2007 and 2017. In total, 19/37 infants (51%, 95% CI: 34-68) had ophthalmic manifestations at any time prior to or at diagnosis; and in 6/37 (16%, 95% CI: 6-32) ophthalmic manifestations were the initial symptom. The most common ophthalmic manifestations were strabismus (n = 7), sunset eyes (n = 6), nystagmus (n = 4), reduced pupillary light reflex (n = 4), and/or decreased vision (n = 4). The median number of symptoms per infant at the time of diagnosis was three (range 0-9). The median diagnostic delay was 26 days (range 0-283, IQR: 6;90). 5-year survival rate was 75% (95% CI: 61-90) and all children with diagnostic delay > 100 days (n = 9, 24%) were still alive at the end of follow-up (median 6.3 years, range 2.2-10.2). CONCLUSION We provide an overview of symptoms and clinical signs in a nation-wide series of infants with CNS tumours and demonstrate that ophthalmic manifestations are frequently observed in infants prior to diagnosis, but, often in combination with other clinical signs. The diagnostic delay was substantial for a large part of the infants, but this was not associated with increased mortality.
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Affiliation(s)
- Nathali J Turanzas
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
| | - René Mathiasen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Sehested
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jeppe K Holtz
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla R Nissen
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sarah L von Holstein
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
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Liu JF, Shanmugavadivel D, Ball-Gamble A, Stewart A, Walker D. Public awareness of childhood, teenager and young adult cancer signs and symptoms in Great Britain: a cross-sectional survey. Arch Dis Child 2023; 108:987-993. [PMID: 37848281 PMCID: PMC10715494 DOI: 10.1136/archdischild-2023-325841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/09/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES To assess public awareness of the risks and symptoms of cancer in children, teenagers, and young adults (CTYA) aged <18 years in Great Britain. METHODS A face-to-face computer-assisted opinion survey was conducted by Ipsos MORI. Participants were a population-based sample of 1000 adults (475 men, 525 women) aged >18 years, with 26% having children aged 6-15 in their households. Questions covered perception about cumulative cancer risk, confidence in recognising signs and symptoms, recognition and perceived urgency of classical signs and symptoms. RESULTS Only 32% of respondents felt confident in recognising CTYA cancer signs and symptoms. Symptoms deemed to require medical assessment within 48 hours by over 50% of participants included seizures/fits, blood in urine or stool, and persistent vomiting. All symptoms except one were selected for assessment within 3 months. On average, respondents identified 10.6 out of 42 classical signs and symptoms. The most recognised symptoms included lump, swelling in pelvis, testicle or breast (46%), blood in urine or stool (44%), changes to moles (43%), lump/swelling in the chest wall or armpits (41%) and weight loss (40%). The least recognised symptoms were early/late puberty (10%), developmental delay in children aged <2 years (11%) and slow growth (13%), with 8%, 2% and 6%, respectively, perceiving no need to discuss them with a doctor. CONCLUSIONS Public awareness of childhood cancer risks and symptoms is substantially lower compared with adult cancer awareness in Great Britain. These findings indicate knowledge and awareness gaps among the general public, highlighting the need for a child cancer awareness campaign.
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Affiliation(s)
- Jo-Fen Liu
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- Children's Cancer and Leukaemia Group, Leicester, UK
| | | | | | | | - David Walker
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
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5
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Canova T, McNinch N, Judd A, Rush S, Wright E. The effects of educational interventions and the COVID-19 pandemic on the time to diagnosis in pediatric patients with primary central nervous system tumors. Neurooncol Pract 2023; 10:437-445. [PMID: 37720393 PMCID: PMC10502781 DOI: 10.1093/nop/npad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Primary central nervous system tumors are a leading cause of death and disability amongst pediatric cancer patients. Akron Children's Hospital published data in 2018 on response time for brain tumor diagnosis and implemented components of an established program to decrease diagnostic delays and thereby reduce tumor- and treatment-related morbidities. This study evaluates if there was an improvement in the total diagnostic interval (TDI, time from symptom onset to diagnosis) after provider education. During the study, the COVID-19 pandemic forced alterations in care delivery. The impact this had on the TDI was also assessed. Methods A retrospective chart review was performed, and patients were separated into 2008-2017 (historical) and 2018-2021 (posteducation) groups to assess the effect of educational interventions on TDI. The posteducation cohort was analyzed separately to assess the impact of COVID-19 pandemic. Results The 85 patients studied in the post-education group showed a median TDI of 31 days. Though not statistically significant (P = .939), this represents an 11-day decrease in median TDI compared to the historical group (42 days). In addition, the posteducation group showed an increase in the average number of healthcare provider visits (HCP, 2.4 historical to 3.2 posteducation, P = .009). The pre-COVID-19 group (median TDI 43.5 days) did not differ statistically from the post-COVID-19 group (30-day median TDI). Conclusion The nonsignificant decrease in TDI and concurrent increase in HCP visits after implementation of education suggests a potential gap amongst providers in working-up primary CNS tumors. These results will influence expansion of education to further improve TDI.
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Affiliation(s)
- Tyler Canova
- Department of Hematology and Oncology, Akron Children’s Hospital, USA
- College of Medicine and Life Sciences, The University of Toledo, USA
| | - Neil McNinch
- Department of Hematology and Oncology, Akron Children’s Hospital, USA
| | - Alexis Judd
- Department of Hematology and Oncology, Akron Children’s Hospital, USA
| | - Sarah Rush
- Department of Hematology and Oncology, Akron Children’s Hospital, USA
| | - Erin Wright
- Department of Hematology and Oncology, Akron Children’s Hospital, USA
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6
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Kehoe K, Sivaguru H, Coulter I, Cowie C. Delay in the diagnosis of paediatric brain tumours: a systematic review. Childs Nerv Syst 2023; 39:2053-2063. [PMID: 37336792 DOI: 10.1007/s00381-023-06022-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023]
Abstract
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.
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Affiliation(s)
- Kristy Kehoe
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
| | - Hansini Sivaguru
- Department of Emergency Medicine, Royal Free Hospital, London, UK
| | - Ian Coulter
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Christopher Cowie
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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Partenope C, Pozzobon G, Weber G, Carceller F, Albanese A. Implications of deferred diagnosis of paediatric intracranial germ cell tumours. Pediatr Blood Cancer 2023; 70:e30168. [PMID: 36582128 DOI: 10.1002/pbc.30168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/31/2022]
Abstract
AIMS This study analysed the clinical features of a cohort of children with intracranial germ cell tumours (IC-GCTs). We retrospectively reviewed timelag between symptoms onset, clinic-radiological findings, diagnosis and outcomes. METHODS Symptoms at diagnosis were divided into four groups: (1) raised intracranial pressure (RICP); (2) visual impairment; (3) endocrinopathies; (4) other. Total diagnostic interval (TDI), defined as the interval between symptom onset (including retrospective recall of symptoms) and definitive diagnosis of IC-GCT, was calculated and compared to survival rates. RESULTS Our cohort included 55 children with median follow-up of 78.9 months (0.5-249.9). The majority (63.6%) had germinomas and 10.9% were metastatic at diagnosis. IC-GCTs were suprasellar (41.8%), pineal (36.4%), bifocal (12.7%) or in atypical sites (9.1%). The most common presenting symptoms were related to RICP (43.6%); however, by the time of tumour diagnosis, 50.9% of patients had developed endocrine dysfunctions. All pineal GCTs manifested with RICP or visual impairment. All suprasellar GCTs presented with endocrinopathies. TDI ranged between 0.25 and 58.5 months (median 4 months). Pineal GCTs had the shortest TDI (median TDI 1 month versus 24 months in suprasellar GCTs, p < .001). TDI > 6 months was observed in 47.3% of patients and was significantly associated with endocrine presenting symptoms. No statistically significant difference was found in progression-free survival and overall survival between patients with TDI > 6 months and with TDI ≤ 6 months. CONCLUSION Approximately half of the IC-GCT patients in this cohort had TDI > 6 months. These presented mostly with endocrine deficits. TDI > 6 months was not associated with increased relapse or mortality rates.
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Affiliation(s)
- Cristina Partenope
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Paediatric Endocrinology, Royal Marsden NHS Foundation Trust, London, UK
| | - Gabriella Pozzobon
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna Weber
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fernando Carceller
- Department of Paediatric and Adolescent Neuro-Oncology and Drug Development Team, Children and Young People's Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Assunta Albanese
- Department of Paediatric Endocrinology, Royal Marsden NHS Foundation Trust, London, UK
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Shanmugavadivel D, Liu JF, Gamble A, Polanco A, Vedhara K, Walker D, Ojha S. Assessing and investigating children with suspected bone and abdominal tumours: an e-Delphi consensus process. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001771. [PMID: 36868779 PMCID: PMC9990668 DOI: 10.1136/bmjpo-2022-001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/03/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND The incidence of childhood cancer has risen by 15% since the 1990s. Early diagnosis is key to optimising outcomes, however diagnostic delays are widely reported. Presenting symptoms are often non-specific causing a diagnostic dilemma for clinicians. This Delphi consensus process was conducted to develop a new clinical guideline for children and young people presenting with signs/symptoms suggestive of a bone or abdominal tumour. METHODS Invitation emails were sent to primary and secondary healthcare professionals to join the Delphi panel. 65 statements were derived from evidence review by a multidisciplinary team. Participants were asked to rank their level of agreement with each statement on a 9-point Likert scale (1=strongly disagree, 9=strongly agree), with responses ≥7 taken to indicate agreement. Statements not reaching consensus were rewritten and reissued in a subsequent round. RESULTS All statements achieved consensus after two rounds. 96/133 (72%) participants responded to round 1 (R1) and 69/96 (72%) completed round 2 (R2). 62/65 (94%) statements achieved consensus in R1 with 29/65 (47%) gaining more than 90% consensus. Three statements did not reach consensus scoring between 61% and 69%. All reached numerical consensus at the end of R2. Strong consensus was reached on best practice of conducting the consultation, acknowledging parental instinct and obtaining telephone advice from a paediatrician to decide the timing and place of review, rather than adult cancer urgent referral pathways. Dissensus in statements was due to unachievable targets within primary care and valid concerns over a potential overinvestigation of abdominal pain. CONCLUSIONS This consensus process has consolidated statements that will be included in a new clinical guideline for suspected bone and abdominal tumours for use in both primary and secondary care. This evidence base will be translated into awareness tools for the public as part of the Child Cancer Smart national awareness campaign.
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Affiliation(s)
| | - Jo-Fen Liu
- Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Ashley Gamble
- Chief Executive's Office, Children's Cancer and Leukaemia Group, Leicester, UK
| | - Angela Polanco
- Chief Executive's Office, Children's Cancer and Leukaemia Group, Leicester, UK
| | - Kavita Vedhara
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - David Walker
- Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Shalini Ojha
- Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.,Centre for Perinatal Research, Lifespan and Population Health, University of Nottingham, Nottingham, UK
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Rajagopal R, Moreira DC, Faughnan L, Wang H, Naqvi S, Krull L, Vasquez L, Diaz-Coronado R, Terao M, Devidas M, Qaddoumi I. An international multicenter survey reveals health care providers' knowledge gap in childhood central nervous system tumors. Eur J Pediatr 2023; 182:557-565. [PMID: 36383283 DOI: 10.1007/s00431-022-04712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/21/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Childhood central nervous system (CNS) tumors have longer delays in diagnosis than do other pediatric malignancies because health care providers (HCPs) lack awareness about clinical presentation of these tumors. To evaluate the knowledge gap among HCPs, we conducted a global cross-sectional survey. The survey consisted of a set of CNS tumor knowledge questions focused on symptoms, signs, and imaging indications. The survey was disseminated to HCPs via email (November 2018-March 2020). Participants had to complete a pre-test survey, attend an education seminar on CNS tumors, and complete a post-test survey. The knowledge gap was evaluated using pre-test and post-test scores. We received 889 pre-test and 392 post-test responses. Most respondents were from Asia (73.1% of pre-test responses; 87.5% of post-test responses). The median pre-test score was 40.0% (range: 13.1-92.9%). A high percentage of correct answers were given in post-test responses (median score: 77.1%, range: 14.9-98.2%). In the pre-test, 18.7% of participants accurately responded that Cushing's triad was a less common symptom, and 15.0% recognized that children aged > 10 years are at risk of late diagnosis. Surprisingly, 21.9% falsely reported that patients with malignancy experienced the longest pre-diagnostic symptom interval, and 54.5% of respondents wrongly selected medulloblastoma as the most common CNS tumor. Overall, pediatricians demonstrated a greater knowledge gap on both surveys than did other specialties. Conclusion: Pre- and post-test surveys revealed significant knowledge gaps in childhood CNS tumors among HCPs. Thus, raising professional awareness on clinical presentations of CNS tumors through educational strategies is important to address this knowledge deficit. What is Known: • Diagnostic delay in childhood central nervous system (CNS) tumors continues to be a significant problem that negatively impacts the quality of life and treatment sequelae. • Lack of medical education on CNS tumors is a contributing factor to this problem. What is New: • Most health care providers do not realize that low-grade tumors are the most common neoplasm in children. • Health care providers fail to recognize that teenagers and adolescents are a vulnerable age group for diagnostic delays, with the longest pre-diagnostic symptom interval.
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Affiliation(s)
- Revathi Rajagopal
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Pediatrics, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Daniel C Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lane Faughnan
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Huiqi Wang
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sameen Naqvi
- Department of Pediatrics, Hematology, and Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Lisa Krull
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Liliana Vasquez
- Centro de Investigación de Medicina de Precision, Universidad de San Martín de Porres, Facultad de Medicina, Lima, Peru.,Unit of Non-Communicable Diseases, Pan American Health Organization, Washington, DC, USA
| | - Rosdali Diaz-Coronado
- Department of Pediatric Oncology, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - Michael Terao
- Office of Student Learning, Georgetown University School of Medicine, Washington, DC, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.
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10
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Yang W, Cai Y, Chen J, Yang P, Ying Z, Liang Y, Ling M, Zhu K, Sun H, Ji Y, Peng X, Zhang N, Ma W, Ge M. Epidemiological characteristics, clinical presentations, and prognoses of pediatric brain tumors: Experiences of national center for children's health. Front Oncol 2023; 13:1067858. [PMID: 36776329 PMCID: PMC9915562 DOI: 10.3389/fonc.2023.1067858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
Background We aimed to describe the epidemiological characteristics, clinical presentations, and prognoses in a national health center for children. Methods From January 2015 to December 2020, 484 patients aged 0-16 years, who were diagnosed with brain tumors and received neurosurgery treatment, were enrolled in the study. Pathology was based on the World Health Organization 2021 nervous system tumor classification, and tumor behaviors were classified according to the International Classification of Diseases for Oncology, third edition. Results Among the 484 patients with brain tumors, the median age at diagnosis was 4.62 [2.19, 8.17] years (benign tumors 4.07 [1.64, 7.13] vs. malignant tumors 5.36 [2.78, 8.84], p=0.008). The overall male-to-female ratio was 1.33:1(benign 1.09:1 vs. malignant 1.62:1, p=0.029). Nausea, vomiting, and headache were the most frequent initial symptoms. The three most frequent tumor types were embryonal tumors (ET, 22.8%), circumscribed astrocytic gliomas (20.0%), and pediatric-type diffuse gliomas (11.0%). The most common tumor locations were the cerebellum and fourth ventricle (38.67%), the sellar region (22.9%) and ventricles (10.6%). Males took up a higher proportion than females in choroid plexus tumors (63.6%), ET (61.1%), ependymal tumors (68.6%), and germ cell tumors (GCTs, 78.1%). Patients were followed for 1 to 82 months. The overall 5-year survival rate was 77.5%, with survival rates of 91.0% for benign tumors and 64.6% for malignant tumors. Conclusion Brain tumors presented particularly sex-, age-, and regional-dependent epidemiological characteristics. Our results were consistent with previous reports and might reflect the real epidemiological status in China.
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Affiliation(s)
- Wei Yang
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yingjie Cai
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jiashu Chen
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ping Yang
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zesheng Ying
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yuting Liang
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Miao Ling
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Kaiyi Zhu
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Hailang Sun
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yuanqi Ji
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xiaojiao Peng
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Nan Zhang
- Department of Pathology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Wenping Ma
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ming Ge
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China,*Correspondence: Ming Ge,
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11
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Walker DA, Aquilina K, Spoudeas H, Pilotto C, Gan HW, Meijer L. A new era for optic pathway glioma: A developmental brain tumor with life-long health consequences. Front Pediatr 2023; 11:1038937. [PMID: 37033188 PMCID: PMC10080591 DOI: 10.3389/fped.2023.1038937] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/13/2023] [Indexed: 04/11/2023] Open
Abstract
Optic pathway and hypothalamic glioma (OPHG) are low-grade brain tumors that arise from any part of the visual pathways frequently involving the hypothalamus. The tumors grow slowly and present with features driven by their precise anatomical site, their age at presentation and the stage of growth and development of the host neural and orbital bony tissues. Up to 50% of optic pathway glioma arise in association with Neurofibromatosis type 1 (NF1), which affects 1 in 3,000 births and is a cancer predisposition syndrome. As low-grade tumors, they almost never transform to malignant glioma yet they can threaten life when they present under two years of age. The main risks are to threaten vision loss by progressive tumor damage to optic pathways; furthermore, invasion of the hypothalamus can lead to diencephalic syndrome in infancy and hypopituitarism later in life. Progressive cognitive and behavioural dysfunction can occur, as part of NF1 syndromic features and in sporadic cases where large bulky tumors compress adjacent structures and disrupt neuro-hypothalamic pathways. Persistently progressive tumors require repeated treatments to attempt to control vision loss, other focal brain injury or endocrine dysfunction. In contrast tumors presenting later in childhood can be seen to spontaneously arrest in growth and subsequently progress after periods of stability. These patterns are influenced by NF status as well as stages of growth and development of host tissues. The past two decades has seen an expansion in our understanding and knowledge of the clinical and scientific features of these tumors, their modes of presentation, the need for careful visual and endocrine assessment. This influences the decision-making surrounding clinical management with surgery, radiotherapy, chemotherapy and most recently, the potential benefit of molecularly targeted drug therapy. This article, based upon the authors' clinical and research experience and the published literature will highlight advances in approach to diagnosis, the established role of vision loss as justification of treatments and the emerging evidence of endocrine and neurological consequences that need to be incorporated into judgements for case selection for therapy or observation. Consideration is given to the current state of biological evidence justifying current trials of new therapies, the genetic studies of the NF1 gene and the potential for new approaches to OPHG detection and treatment. The outstanding health system priorities from the perspective of children, their parents and health system commissioners or insurers are discussed.
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Affiliation(s)
- David A. Walker
- Emeritus Professor Paediatric Oncology, University of Nottingham, Nottingham, United Kingdom
- Correspondence: David A. Walker
| | - Kristian Aquilina
- Department of NeuroEndocrinology, Great Ormond Street Hospital, London, United Kingdom
| | - Helen Spoudeas
- Department of NeuroEndocrinology, Great Ormond Street Hospital, London, United Kingdom
| | - Chiara Pilotto
- Pediatric Clinic, ASUFC Santa Maria Della Misericordia, Udine, Italy
| | - Hoong-Wei Gan
- Department of NeuroEndocrinology, Great Ormond Street Hospital, London, United Kingdom
| | - Lisethe Meijer
- Kinderoncologie, Prinses Máxima Centrum Voor Kinderoncologie BV, Utrecht, Netherlands
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12
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Epidemiology of pediatric central nervous system tumors in Uyghur: experience from a single center. Childs Nerv Syst 2022; 39:909-914. [PMID: 36456749 PMCID: PMC9715407 DOI: 10.1007/s00381-022-05766-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Retrospective analysis of clinical and epidemiological characteristics of central nervous system (CNS)tumors in Uyghur children from a single center in Xinjiang. METHODS Between January 2013 and December 2021, 243 children (0-17 years old) with a clear pathological type of CNS tumor are collected and analyzed for tumor size, grade, and category, as well as their relationship with the child's gender, age, and region of origin according to the 2021 edition of the new WHO CNS tumor classification. OUTCOME The 243 cases of CNS tumors in Uyghur children are predominantly from rural areas, with 144 cases (59.26%) of supratentorial tumors and 129 cases (53.09%) of low-grade tumors. With an overall male-to-female ratio of 1.43:1, a peak age of incidence of 6 to 8 years. CONCLUDING The present study is based on a 9-year analysis of pediatric CNS data from a single center, and the center is the largest tertiary hospital in Xinjiang with large numbers of admitted patients, which may reflect some extent the clinical characteristics and epidemiological features characteristics of pediatric CNS tumors in Uyghur in Xinjiang.
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13
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Amayiri N, Sarhan N, Yousef Y, Ibrahimi AK, Abu-Shanab S, Al-Zebin Z, Al-Hussaini M, Musharbash A, Tawalbeh A, Bouffet E, Bartels U. Feasibility of treating pediatric intracranial germ cell tumors in a middle-income country: The Jordanian experience. Pediatr Blood Cancer 2022; 69:e30011. [PMID: 36131594 DOI: 10.1002/pbc.30011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/16/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pediatric intracranial germ cell tumors (iGCT) are rare, with limited data available from Arabic countries. METHODS We retrospectively reviewed the medical charts of children <18 years diagnosed with iGCT at King Hussein Cancer Center/Jordan (January 2003 to December 2020) for clinical characteristics, treatment, and morbidities. RESULTS Sixteen patients had germinoma; median age was 6.9 years and median symptoms duration 8 months. Nine tumors were suprasellar, five pineal, and two bifocal. Four were metastatic. Eight patients had slightly elevated beta subunit human chorionic gonadotropin and 11 patients had resection/biopsy. Fifteen patients received chemotherapy; mostly carboplatin (450 mg/m2 )/etoposide, which had low toxicity. All patients received radiotherapy (different doses and fields). At median follow-up of 7.7 years, one tumor recurred (progression-free survival: 91% ± 8%). Twelve patients who continued follow-up had stable visual and endocrine deficits to their initial presentation. Five finished or are finishing diploma and seven had poor school performance (four left school). Six patients were diagnosed with nongerminomatous germ cell tumor; median symptom duration was 1 month. Three tumors were pineal, two suprasellar, and one at quadrigeminal plate. Three were metastatic. Five tested patients had high tumor markers and four had resection/biopsy. All patients received chemotherapy, and then five received craniospinal radiation. Two patients are alive, two died with tumor progression, one died in remission with electrolyte imbalance, and one developed leukemia and died with septic shock. CONCLUSIONS We achieved excellent survival in treating germinoma using a feasible protocol for low middle-income countries. However, patients encountered significant morbidities exacerbated by delayed diagnosis and unnecessary surgical interventions despite abnormal tumor markers. Raising awareness on iGCT symptomatology and diagnosis may help limit these morbidities.
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Affiliation(s)
- Nisreen Amayiri
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Nasim Sarhan
- Radiation Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Yacoub Yousef
- Surgery Department, Ophthalmology Division, King Hussein Cancer Center, Amman, Jordan
| | - Ahmed Kh Ibrahimi
- Radiation Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Sobuh Abu-Shanab
- Psychosocial Oncology Program, King Hussein Cancer Center, Amman, Jordan
| | - Zebin Al-Zebin
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Awni Musharbash
- Surgery Department, Neurosurgery Division, King Hussein Cancer Center, Amman, Jordan
| | - Ahmed Tawalbeh
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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14
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Rask O, Nilsson F, Lähteenmäki P, Ehrstedt C, Holm S, Sandström PE, Nyman P, Sabel M, Grillner P. Prospective registration of symptoms and times to diagnosis in children and adolescents with central nervous system tumors: A study of the Swedish Childhood Cancer Registry. Pediatr Blood Cancer 2022; 69:e29850. [PMID: 35727740 DOI: 10.1002/pbc.29850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/10/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The elapsed time taken to diagnose tumors of the central nervous system in children and adolescents varies widely. The aim of the present study was to investigate such diagnostic time intervals at a national level in Sweden as they correlate with clinical features. METHODS Data prospectively accumulated over a 4-year period in the Swedish Childhood Cancer Registry from patients aged 0-18 years were pooled, and diagnostic time intervals were analyzed considering tumor location, tumor type, patient age and sex, initial symptoms, and clinical timelines. All six pediatric oncology centers in Sweden contributed to collection of data. Time points for calculating the total diagnostic interval (TDI) defined as the time from symptom onset to diagnosis were reported in 257 of 319 patients (81%). RESULTS The time from symptom onset to the first healthcare consultation, median 2.6 weeks, did not vary significantly between patients categorized according to tumor type or location. The median TDI was 8.3 weeks for the 4-year study period. Patients with optic pathway glioma (TDI 26.6 weeks), those with tumors of the spinal cord (TDI 25.9 weeks), and those with midline tumors (TDI 24.6 weeks) had the longest lead times. Additionally, older age, too few initial symptoms, and seeking initial redress outside an emergency ward were factors associated with a longer time to diagnosis. CONCLUSION This study identified several factors associated with delayed diagnosis of central nervous system tumors among Swedish children and adolescents. These novel data ought to help direct future efforts toward clinical improvement.
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Affiliation(s)
- Olof Rask
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Pediatrics, Skåne University Hospital Lund, Lund, Sweden.,Psychiatry, Habilitation and Aid, Child and Adolescent Psychiatry, Region Skåne, Malmö, Sweden
| | - Fredrik Nilsson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Päivi Lähteenmäki
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Pediatric and Adolescent Medicine, Turku University Hospital, and FICAN-West, University of Turku, Turku, Finland
| | - Christoffer Ehrstedt
- Department of Women´s and Children´s Health, Uppsala University, and Uppsala University Children´s Hospital, Uppsala, Sweden
| | - Stefan Holm
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Per Nyman
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Imaging and Visualization (CMIV), University Hospital in Linköping, Linköping, Sweden
| | - Magnus Sabel
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pernilla Grillner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | -
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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15
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Claude F, Ubertini G, Szinnai G. Endocrine Disorders in Children with Brain Tumors: At Diagnosis, after Surgery, Radiotherapy and Chemotherapy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1617. [PMID: 36360345 PMCID: PMC9688119 DOI: 10.3390/children9111617] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Brain tumors are the second most frequent type of all pediatric malignancies. Depending on their localization, patients with brain tumors may present neurological or ophthalmological symptoms, but also weight anomalies and endocrine disorders ranging from growth hormone deficiency, anomalies of puberty, diabetes insipidus to panhypopituitarism. Immediately at diagnosis, all patients with brain tumors require a complete assessment of the hypothalamic-pituitary function in order to address eventual endocrine disorders. Moreover, children and adolescents undergoing brain surgery must receive peri- and postoperative hydrocortisone stress therapy. Post-operative disorders of water homeostasis are frequent, ranging from transient diabetes insipidus, as well as syndrome of inappropriate antidiuretic hormone secretion to persistent diabetes insipidus. Late endocrine disorders may result from surgery near or within the hypothalamic-pituitary region. Pituitary deficits are frequent after radiotherapy, especially growth hormone deficiency. Thyroid nodules or secondary thyroid cancers may arise years after radiotherapy. Gonadal dysfunction is frequent after chemotherapy especially with alkylating agents. CONCLUSION Early detection and treatment of specific endocrine disorders at diagnosis, perioperatively, and during long-term follow-up result in improved general and metabolic health and quality of life.
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Affiliation(s)
- Fabien Claude
- Department of Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Graziamaria Ubertini
- Department of Pediatric Endocrinology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Gabor Szinnai
- Department of Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, 4056 Basel, Switzerland
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16
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Sherman SJ, Tanaka R, Qaddoumi I. Psychiatric symptoms in children with low-grade glioma and craniopharyngioma: A systematic review. J Psychiatr Res 2022; 148:240-249. [PMID: 35149436 DOI: 10.1016/j.jpsychires.2022.01.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
The presentation of psychiatric symptoms in pediatric low-grade brain tumors is challenging because this can delay proper diagnosis and treatment. We performed a systematic review of psychiatric presenting symptoms of low-grade brain tumors in pediatric patients. We searched the PubMed and Web of Science databases of studies published in English from 1977 until 2019 reporting patients aged ≤21 years at the time of tumor diagnosis who exhibited psychiatric/behavioral symptoms before diagnosis of low-grade glioma (LGG), pilocytic astrocytoma (PA), or craniopharyngioma (CP). Our systematic search strategy coupled each tumor type with patient age and presenting symptoms by using different variations of the search terms "childhood" and "psychiatric symptoms" or "behavioral symptoms." We identified six unique articles that met our inclusion criteria in the LGG search, 27 in the PA search, and 32 in the CP search. Six patients were included in the LGG articles (age range, 3-16 years), 75 in the PA articles (age range, 0.5-21 years), and 87 in the CP articles (age range, 0.67-21 years). The most common presenting symptoms included eating disorders (n = 64) and behavioral changes (n = 49). Our findings demonstrate the need to establish clear criteria for neuroimaging indications for pediatric patients exhibiting eating disorders.
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Affiliation(s)
- Sarah J Sherman
- St. Jude Children's Research Hospital Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ryuma Tanaka
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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17
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Boiardi F, Stebbing J. Developments in paediatric cancer care throughout the COVID-19 pandemic: Lessons from China. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 20:100398. [PMID: 35194588 PMCID: PMC8853831 DOI: 10.1016/j.lanwpc.2022.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College, London, UK
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18
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Shanmugavadivel D, Liu JF, Ball-Gamble A, Polanco A, Vedhara K, Walker D, Ojha S. The Childhood Cancer Diagnosis (CCD) Study: a UK observational study to describe referral pathways and quantify diagnostic intervals in children and young people with cancer. BMJ Open 2022; 12:e058744. [PMID: 35173012 PMCID: PMC8852751 DOI: 10.1136/bmjopen-2021-058744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Childhood cancer is diagnosed in 400 000 children and young people (CYP) aged 0-19 years worldwide annually. In the UK, a child's cumulative cancer risk increases from 1 in 4690 from birth to aged 1, to 1 in 470 by age 15. Once diagnosed, access to treatments offers survival to adulthood for over 80%. Tumour diagnoses are at a later stage and mortality is higher when compared with those in other parts of Europe. This means higher risk, more intensive therapies for a cure. Some CYPs are known to experience delays to diagnosis which may further contribute to poor outcomes. This study aims to understand the current pathway of childhood cancer referrals and diagnosis and quantify diagnostic intervals in the UK. METHODS AND ANALYSIS This is a prospective multicentre observational study including all tertiary childhood cancer treatment centres in the UK. CYP (0-18 years) with a new diagnosis of cancer over the study period will be invited to participate. Data will be collected at initial diagnosis and 5 years after diagnosis. Data will include demographic details, clinical symptoms, tumour location, stage and clinical risk group. In addition, key diagnostic dates and referral routes will be collected to calculate the diagnostic intervals. At 5 years' follow-up, data will be collected on refractory disease, relapse and 1-year and 5-year survival. Population characteristics will be presented with descriptive analyses with further analyses stratified by age, geographical region and cancer type. Associations between diagnostic intervals/delay and risk factors will be explored using multiple regression and logistic regression. ETHICS The study has favourable opinion from the York and Humber, Leeds West REC (19/YH/0416). DISSEMINATION Results will be presented at academic conferences, published in peer-reviewed journals and disseminated through public messaging in collaboration with our charity partners through a national awareness campaign (ChildCancerSmart). STUDY REGISTRATION researchregistry.com (researchregistry5313).
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Affiliation(s)
- Dhurgshaarna Shanmugavadivel
- Academic Unit of Population and Lifespan Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Jo-Fen Liu
- Academic Unit of Population and Lifespan Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ashley Ball-Gamble
- Chief Executive Office, Children's Cancer and Leukaemia Group, Leicester, UK
| | - Angela Polanco
- Chief Executive Office, Children's Cancer and Leukaemia Group, Leicester, UK
| | - Kavita Vedhara
- Academic Unit of Population and Lifespan Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - David Walker
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Shalini Ojha
- Academic Unit of Population and Lifespan Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
- Children's Hospital, University Hospitals of Derby and Burton NHS Trust, Derby, UK
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19
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Oigman G, Osorio DS, Ferman S, Stanek JR, Aversa do Souto A, Christiani MMC, Magalhaes DMA, Finlay JL, Vianna DA. Epidemiological characteristics and survival outcomes of children with medulloblastoma treated at the National Cancer Institute (INCA) in Rio de Janeiro, Brazil. Pediatr Blood Cancer 2022; 69:e29274. [PMID: 34767315 DOI: 10.1002/pbc.29274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Medulloblastoma (MB),the most common malignant brain tumor of childhood has survival outcomes exceeding 80% for standard-risk and 60% for high-risk patients in high-income countries (HICs). These results have not been replicated in low- and middle-income countries (LMICs), where 80% of children with cancer live. METHODS This is a retrospective review of 114 children aged 3-18 years diagnosed with MB from 1997 to 2016 at National Cancer Institute (INCA). Sociodemographic, clinical, and treatment data were extracted from the medical records and summarized descriptively. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. RESULTS The male-to-female ratio was 1.32 and the median age at diagnosis was 8.2 years. Headache (83%) and nausea/vomiting (78%) were the most common presenting symptoms. Five-year OS was 59.1% and PFS was 58.4%. The OS for standard-risk and high-risk patients was 69% and 53%, respectively. The median time to diagnosis interval was 50.5 days and the median time from surgery to radiation therapy initiation was 50.4 days. Patients who lived >40 km from INCA fared better (OS = 68.2% vs. 51.1%, p = .032). Almost 20% of families lived below the Brazilian minimum wage. Forty-five patients (35%) had metastatic disease at admission. Gross total resection was achieved in 57% of the patitents. CONCLUSIONS Although there are considerable barriers to deliver effective MB treatment in countries like Brazil, the OS seen in the present study demonstrates that good outcomes are not only feasible but can and should be increased with appropriate interventions.
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Affiliation(s)
- Gabriela Oigman
- Division of Pediatric Oncology, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diana S Osorio
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Sima Ferman
- Division of Pediatric Oncology, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joseph R Stanek
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | - Marcio M C Christiani
- Division of Neurosurgery, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Denise M A Magalhaes
- Division of Radiation Oncology, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonathan L Finlay
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Denizar A Vianna
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Jogendran M, Ronsley R, Goldman RD, Cheng S. Perceived Barriers to the Time to Diagnosis of Central Nervous System Tumors in Children: Surveying the Perspectives From the Frontline. J Pediatr Hematol Oncol 2021; 43:e1262-e1265. [PMID: 34133384 DOI: 10.1097/mph.0000000000002245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Rebecca Ronsley
- Department of Medicine, University of British Columbia
- Department of Pediatrics, Division of Hematology/Oncology/BMT
| | - Ran D Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program Department of Pediatrics, University of British Columbia, and the BC Children's Research Institute, Vancouver, BC, Canada
| | - Sylvia Cheng
- Department of Medicine, University of British Columbia
- Department of Pediatrics, Division of Hematology/Oncology/BMT
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21
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Goldman RD, Cochrane DD, Dahiya A, Mah H, Buttar A, Lambert C, Cheng S. Finding the Needle in the Hay Stack: Population-based Study of Prediagnostic Symptomatic Interval in Children With CNS Tumors. J Pediatr Hematol Oncol 2021; 43:e1093-e1098. [PMID: 33235150 DOI: 10.1097/mph.0000000000002012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
Central nervous system (CNS) tumors in children are a devastating diagnosis and delay in diagnosis is well documented in the literature. The aim of this study was to document and characterize time to diagnosis of CNS tumors among children 0 to 17 years of age in a pediatric center. A retrospective chart review was conducted of medical records of children with CNS tumors from 2000 to 2016 in British Columbia, Canada and 148 reports were available for review. Average age at diagnosis was 87.8 months (SD=59.7; median=72). One third (30%) were diagnosed after a single visit to a health care provider and 11 (7.7%) after more than 4 visits. Median time to diagnosis (prediagnostic symptomatic interval [PSI]) was 62 days (average 197±341 d; range, 0 to 2047 d). Longest period was time from first symptom to first health care provider visit (PSI1, median 37 d). Tumors in the posterior fossa and symptoms of ataxia or paresis were associated with a significantly shorter PSI. CNS tumors in children continue to pose a diagnostic challenge with variability in time to diagnosis. Our population-based study suggests variability in time to diagnosis with a need for education of families to identify symptoms associated with CNS tumors.
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Affiliation(s)
- Ran D Goldman
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics, University of British Columbia
| | | | - Anita Dahiya
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics, University of British Columbia
| | - Heidi Mah
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics, University of British Columbia
| | - Arsh Buttar
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics, University of British Columbia
| | - Clare Lambert
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics, University of British Columbia
| | - Sylvia Cheng
- Pediatrics, Division of Hematology/Oncology/BMT, University of British Columbia, BC Children's Research Institute, Vancouver, BC, Canada
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22
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Affiliation(s)
- Chris McKinnon
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Meera Nandhabalan
- Department of Clinical Oncology, Oxford University Hospitals NHS Foundation Trust
| | - Scott A Murray
- Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, Primary Palliative Care Research Group, University of Edinburgh, Edinburgh, UK
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
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Hu C, Iwasaki M, Liu Z, Wang B, Li X, Lin H, Li J, Li JV, Lian Q, Ma D. Lung but not brain cancer cell malignancy inhibited by commonly used anesthetic propofol during surgery: Implication of reducing cancer recurrence risk. J Adv Res 2021; 31:1-12. [PMID: 34194828 PMCID: PMC8240101 DOI: 10.1016/j.jare.2020.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/27/2020] [Accepted: 12/12/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Intravenous anesthesia with propofol was reported to improve cancer surgical outcomes when compared with inhalational anesthesia. However, the underlying molecular mechanisms largely remain unknown. Objectives The anti-tumor effects of propofol and the possible underlying mechanism including altered metabolic and signaling pathways were studied in the current study. Methods The cell viability, proliferation, migration, and invasion of cancer cells were analyzed with CCK-8, Ki-67 staining, wound healing, and Transwell assay, respectively. The protein changes were analyzed with Western blot and immunofluorescent staining. The metabolomics alteration was studied with 1H-NMR spectroscopy. The gene expression regulations were analyzed with PCR gene array and qRT-PCR experiments. Results In this study, we found that propofol reduced cell viability and inhibited cell proliferation, migration and invasion of lung cancer cells, but not neuroglioma cells. In lung cancer cells, propofol downregulated glucose transporter 1 (GLUT1), mitochondrial pyruvate carrier 1 (MPC1), p-Akt, p-Erk1/2, and hypoxia- inducible factor 1 alpha (HIF-1 α ) expressions and upregulated pigment epithelium-derived factor (PEDF) expression. Propofol increased intracellular glutamate and glycine but decreased acetate and formate whilst increased glucose, lactate, glutamine, succinate, pyruvate, arginine, valine, isoleucine, and leucine and glycerol, and decreased acetate, ethanol, isopropanol in the culture media of lung cancer cells. Furthermore, VEGFA, CTBP1, CST7, CTSK, CXCL12, and CXCR4 gene expressions were downregulated, while NR4A3, RB1, NME1, MTSS1, NME4, SYK, APC, and FAT1 were upregulated following the propofol treatment. Consistent with the phenotypical changes, these molecular and metabolic changes were not found in the neuroglioma cells. Conclusion Our findings indicated anti-tumor effects of propofol on the lung cancer but not brain cancer, through the regulation of tumor metastasis-related genes, multi-cellular signaling and cellular metabolism.
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Affiliation(s)
- Cong Hu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, United Kingdom
| | - Masae Iwasaki
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, United Kingdom
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Zhigang Liu
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom
| | - Bincheng Wang
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, United Kingdom
| | - Xiaomeng Li
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, United Kingdom
| | - Han Lin
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Jun Li
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Jia V. Li
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom
| | - Qingquan Lian
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, United Kingdom
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Yamada Y, Kobayashi D, Terashima K, Kiyotani C, Sasaki R, Michihata N, Kobayashi T, Ogiwara H, Matsumoto K, Ishiguro A. Initial symptoms and diagnostic delay in children with brain tumors at a single institution in Japan. Neurooncol Pract 2021; 8:60-67. [PMID: 33664970 DOI: 10.1093/nop/npaa062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background A prolonged interval between onset of symptoms and diagnosis of childhood brain tumor is associated with worse neurological outcomes. The objectives of this study are to determine factors contributing to diagnostic delay and to find an interventional focus for further reduction in the interval between symptom onset and diagnosis in Japan. Methods We retrospectively analyzed 154 patients younger than 18 years with newly diagnosed brain tumors who visited our institution from January 2002 to March 2013. Results The median age at diagnosis was 6.2 years and the median total diagnostic interval (TDI) was 30 days. Patients with low-grade tumors and cerebral midline tumor location had significantly long TDI. Durations between the first medical consultation and diagnosis (diagnostic interval, DI) were exceedingly longer for patients with visual, hearing, or smelling abnormalities as the first symptom (median, 303 days). TDI and DI of patients who visited ophthalmologists or otolaryngologist for the first medical consultation were significantly longer. Among these patients, longer DI was associated with worse visual outcome. Conclusion Raising awareness of brain tumor diagnosis among ophthalmologists and otolaryngologists may reduce diagnostic delay and may improve the neurological impairment of children with brain tumors in Japan.
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Affiliation(s)
- Yuji Yamada
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Daiki Kobayashi
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Keita Terashima
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Chikako Kiyotani
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Ryuji Sasaki
- Division of Pediatric Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Nobuaki Michihata
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Toru Kobayashi
- Department of Management and Strategy, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hideki Ogiwara
- Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan
| | - Kimikazu Matsumoto
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
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25
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Foster MT, Hennigan D, Grayston R, van Baarsen K, Sunderland G, Millward CP, Lalgudi Srinivasan H, Ferguson D, Totimeh T, Pizer B, Mallucci C. Reporting morbidity associated with pediatric brain tumor surgery: are the available scoring systems sufficient? J Neurosurg Pediatr 2021; 27:556-565. [PMID: 33636703 DOI: 10.3171/2020.9.peds20556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Complications in pediatric neurooncology surgery are seldom and inconsistently reported. This study quantifies surgical morbidity after pediatric brain tumor surgery from the last decade in a single center, using existing morbidity and outcome measures. METHODS The authors identified all pediatric patients undergoing surgery for an intracranial tumor in a single tertiary pediatric neurosurgery center between January 2008 and December 2018. Complications between postoperative days 0 and 30 that had been recorded prospectively were graded using appropriate existing morbidity scales, i.e., the Clavien-Dindo (CD), Landriel, and Drake scales. The result of surgery with respect to the predetermined surgical aim was also recorded. RESULTS There were 477 cases (364 craniotomies and 113 biopsies) performed on 335 patients (188 males, median age 9 years). The overall 30-day mortality rate was 1.26% (n = 6), and no deaths were a direct result of surgical complication. Morbidity on the CD scale was 0 in 55.14%, 1 in 10.69%, 2 in 18.66%, 3A in 1.47%, 3B in 11.74%, and 4 in 1.05% of cases. Morbidity using the Drake classification was observed in 139 cases (29.14%). Neurological deficit that remained at 30 days was noted in 8.39%; 78% of the returns to the operative theater were for CSF diversion. CONCLUSIONS To the authors' knowledge, this is the largest series presenting outcomes and morbidity from pediatric brain tumor surgery. The mortality rate and morbidity on the Drake classification were comparable to those of published series. An improved tool to quantify morbidity from pediatric neurooncology surgery is necessary.
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Affiliation(s)
- Mitchell T Foster
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool.,2Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool.,3Cancer Research UK Brain Tumour Centre of Excellence, The University of Edinburgh
| | - Dawn Hennigan
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Rebecca Grayston
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Kirsten van Baarsen
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Geraint Sunderland
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool.,2Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool
| | - Christopher Paul Millward
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool.,2Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool
| | | | - Deborah Ferguson
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool.,4Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester; and
| | - Teddy Totimeh
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Barry Pizer
- 5Department of Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Conor Mallucci
- 1Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool
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Maaz AUR, Yousif T, Saleh A, Pople I, Al-Kharazi K, Al-Rayahi J, Elkum N, Malik M. Presenting symptoms and time to diagnosis for Pediatric Central Nervous System Tumors in Qatar: a report from Pediatric Neuro-Oncology Service in Qatar. Childs Nerv Syst 2021; 37:465-474. [PMID: 32710251 PMCID: PMC7835301 DOI: 10.1007/s00381-020-04815-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There are no previous published reports on primary pediatric tumors of the central nervous system (CNS) in Qatar. We undertook this retrospective cohort study to review the diagnosis of CNS tumors in children in Qatar to analyze the presentation characteristics including symptoms, referral pathways, and time to diagnosis. METHODS All children registered with Pediatric Neuro-Oncology service (PNOS) were included in the study. Data from the time of diagnosis (October 2007 to February 2020) were reviewed retrospectively. Presenting symptoms were recorded and pre-diagnosis symptom interval (PSI) was calculated from the onset of the first symptom to the date of diagnostic imaging. RESULTS Of the 61 children registered with PNOS during the study period, 51 were included in the final analysis. Ten children were excluded because they were either diagnosed outside Qatar (n = 7) or were asymptomatic at the time of diagnosis (n = 3). The median age was 45 (range 1-171) months. Common tumor types included low-grade glioma (LGG) (47.1%) and medulloblastoma/primitive neuro-ectodermal tumors (PNET) (23.5%). Nine children had an underlying neurocutaneous syndrome. Thirty-eight patients (74.5%) had at least one previous contact with healthcare (HC) professional, but 27 (52%) were still diagnosed through the emergency department (ED). Presenting symptoms included headache, vomiting (36.2%), oculo-visual symptoms (20.6%), motor weakness (18.9%), seizures, ataxia (17.2% each), irritability, cranial nerve palsies (12% each), and endocrine symptoms (10.3%). Median PSI was 28 days (range 1-845 days) for all CNS tumors. Longest PSI was seen with germ cell tumors (median 146 days), supratentorial location (39 days), and age above 3 years (30 days). Tumor characteristics of biological behavior (high-grade tumor) and location (infratentorial) were significantly associated with shorter PSI, as were presenting symptoms of ataxia, head tilt, and altered consciousness. CONCLUSIONS Although overall diagnostic times were acceptable, some tumor types were diagnosed after a significant delay. The awareness campaign, such as the "HeadSmart" campaign in the United Kingdom (UK), can improve diagnostic times in Qatar. Further research is required to better understand the reasons for the delay.
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Affiliation(s)
- Ata U R Maaz
- Department of Child Health, Division of Pediatric Hematology/Oncology, Sidra Medicine, Al-Luqta Street, PO Box: 26999, Doha, Qatar.
| | - Tayseer Yousif
- Department of Child Health, Division of Pediatric Hematology/Oncology, Sidra Medicine, Al-Luqta Street, PO Box: 26999, Doha, Qatar
| | - Ayman Saleh
- Department of Child Health, Division of Pediatric Hematology/Oncology, Sidra Medicine, Al-Luqta Street, PO Box: 26999, Doha, Qatar
| | - Ian Pople
- Department of Pediatric Surgery, Division of Neurosurgery, Sidra Medicine, Doha, Qatar
| | - Khalid Al-Kharazi
- Department of Pediatric Surgery, Division of Neurosurgery, Sidra Medicine, Doha, Qatar
| | - Jehan Al-Rayahi
- Department of Radiology, Division of Neuro-imaging, Sidra Medicine, Doha, Qatar
| | - Naser Elkum
- Department of Biostatistics, Sidra Medicine, Doha, Qatar
| | - Muzaffar Malik
- Division of Medical Education, University of Brighton, Falmer, Brighton, BN1 9PH, UK
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Grant R, Dowswell T, Tomlinson E, Brennan PM, Walter FM, Ben-Shlomo Y, Hunt DW, Bulbeck H, Kernohan A, Robinson T, Lawrie TA. Interventions to reduce the time to diagnosis of brain tumours. Cochrane Database Syst Rev 2020; 9:CD013564. [PMID: 32901926 PMCID: PMC8082957 DOI: 10.1002/14651858.cd013564.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brain tumours are recognised as one of the most difficult cancers to diagnose because presenting symptoms, such as headache, cognitive symptoms, and seizures, may be more commonly attributable to other, more benign conditions. Interventions to reduce the time to diagnosis of brain tumours include national awareness initiatives, expedited pathways, and protocols to diagnose brain tumours, based on a person's presenting symptoms and signs; and interventions to reduce waiting times for brain imaging pathways. If such interventions reduce the time to diagnosis, it may make it less likely that people experience clinical deterioration, and different treatment options may be available. OBJECTIVES To systematically evaluate evidence on the effectiveness of interventions that may influence: symptomatic participants to present early (shortening the patient interval), thresholds for primary care referral (shortening the primary care interval), and time to imaging diagnosis (shortening the secondary care interval and diagnostic interval). To produce a brief economic commentary, summarising the economic evaluations relevant to these interventions. SEARCH METHODS For evidence on effectiveness, we searched CENTRAL, MEDLINE, and Embase from January 2000 to January 2020; Clinicaltrials.gov to May 2020, and conference proceedings from 2014 to 2018. For economic evidence, we searched the UK National Health Services Economic Evaluation Database from 2000 to December 2014. SELECTION CRITERIA We planned to include studies evaluating any active intervention that may influence the diagnostic pathway, e.g. clinical guidelines, direct access imaging, public health campaigns, educational initiatives, and other interventions that might lead to early identification of primary brain tumours. We planned to include randomised and non-randomised comparative studies. Included studies would include people of any age, with a presentation that might suggest a brain tumour. DATA COLLECTION AND ANALYSIS Two review authors independently assessed titles identified by the search strategy, and the full texts of potentially eligible studies. We resolved discrepancies through discussion or, if required, by consulting another review author. MAIN RESULTS We did not identify any studies for inclusion in this review. We excluded 115 studies. The main reason for exclusion of potentially eligible intervention studies was their study design, due to a lack of control groups. We found no economic evidence to inform a brief economic commentary on this topic. AUTHORS' CONCLUSIONS In this version of the review, we did not identify any studies that met the review inclusion criteria for either effectiveness or cost-effectiveness. Therefore, there is no evidence from good quality studies on the best strategies to reduce the time to diagnosis of brain tumours, despite the prioritisation of research on early diagnosis by the James Lind Alliance in 2015. This review highlights the need for research in this area.
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Affiliation(s)
- Robin Grant
- Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Edinburgh, UK
| | - Therese Dowswell
- C/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Eve Tomlinson
- Cochrane Gynaecological, Neuro-oncology and Orphan Cancers, 1st Floor Education Centre, Royal United Hospital, Bath, UK
| | - Paul M Brennan
- Translational Neurosurgery Department, Western General Hospital, Edinburgh, UK
| | - Fiona M Walter
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - David William Hunt
- Foundation School/Dept of Clinical and Experimental Medicine, Royal Surrey County Hospital/University of Surrey, Guildford, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Barragán-Pérez EJ, Altamirano-Vergara CE, Alvarez-Amado DE, García-Beristain JC, Chico-Ponce-de-León F, González-Carranza V, Juárez-Villegas L, Murata C. The Role of Time as a Prognostic Factor in Pediatric Brain Tumors: a Multivariate Survival Analysis. Pathol Oncol Res 2020; 26:2693-2701. [PMID: 32661835 DOI: 10.1007/s12253-020-00875-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/09/2020] [Indexed: 12/29/2022]
Abstract
There is no evidence that prolonged pre diagnostic symptomatic intervals (PSI) increases the risk of death in pediatric brain tumors. When investigating the role of time previous research had not controlled for confounding variables or measured the pretreatment interval (PTI). We use the term global delay interval (GDI) to describe the sum of PSI and PTI. The aim of this research was to evaluate whether there was a decrease in the probability of survival in children with brain tumors due to a prolonged PSI, PTI and GDI, using a multivariate survival analysis. We retrospective review 127 clinical records labeled with the diagnosis of CNS tumors attended at a specialized pediatric center in Mexico City from January 2008 to December 2012. Patients with PSI and GDI diagnosed between 3 and 6 months showed statistical lower probability of surviving that those with intervals <3 months even when adjusting for age, sex, localization and tumor grade. When stratified for the place of residency and adjusted for sex, age, localization, grade of tumor, type of surgery and coadjuvant therapy, a GDI between 3 and 6 months showed to be a risk factor for the overall survival of brain tumors compared with an interval < 3 months. When analyzing the interaction, high grade tumors are at more risk of dying when GDI was between 3 and 6 months compared to <3 months. Prolonged PSI and GDI showed to be a potential prognostic factor for survival in CNS tumors, especially in high grade tumors. Future prospective research should measure the PSI, PTI and GDI and adjust for covariates in order to properly infer the effect of time in pediatric brain tumors.
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Affiliation(s)
| | | | - Daniel Eduardo Alvarez-Amado
- Pediatric Neurology Department "Hospital Infantil de México Federico Gómez", Mexico City, Mexico. .,Hospital Infantil de México Federico Gómez, Calle Doctor Márquez 162, Alcadía Doctores, Cuauhtémoc, 06720, Ciudad de México, Mexico.
| | | | | | | | - Luis Juárez-Villegas
- Pediatric Oncology Department "Hospital Infantil de México Federico Gómez", Mexico City, Mexico
| | - Chiharu Murata
- Research Methodology Department, Instituto Nacional de Pediatria, Mexico City, Mexico
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Shanmugavadivel D, Liu JF, Murphy L, Wilne S, Walker D. Accelerating diagnosis for childhood brain tumours: an analysis of the HeadSmart UK population data. Arch Dis Child 2020; 105:355-362. [PMID: 31653616 DOI: 10.1136/archdischild-2018-315962] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 07/23/2019] [Accepted: 09/20/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND HeadSmart, a public and professional awareness campaign, was launched to enhance awareness of brain tumour symptomatology identified in the Royal College of Paediatrics and Child Health, National Institute for Health and Care Excellence-accredited guideline. Quality improvement data showed a reduction in diagnostic interval nationally. To reach the government target of 4 weeks, we need to identify subgroups with ongoing delays. METHODS Incident cases of brain tumours (0-18) diagnosed between January 2011 and May 2013 across 18 UK centres were included. Anonymised data including demographics, diagnosis and date of symptom onset/presentation were collected. Key outcome measures, total diagnostic interval (TDI), patient interval (PI) and system interval (SI) were calculated. Subanalysis by age, tumour grade and location was also performed. RESULTS Young children (0-5 years) accounted for 38% of cases, with a peak age at diagnosis of 2 years. Central tumours experienced longest intervals with a median TDI of 10.5 weeks, PI of 3.2 weeks and SI of 2.9 weeks. Craniopharyngioma, low-grade glioma and optic pathway gliomas had the longest TDIs with a median of 15.1, 11.9 and 10.4 weeks, respectively. The greatest proportion of delay was in the SI. The 12-18 age group had a median TDI of 12.1 weeks, compared with 8 weeks for the 5-11 age group and 6 weeks for the 0-5 age group (p<0.001). CONCLUSIONS Clear patterns of intervals for different age groups and anatomical locations have been demonstrated. Tailoring education and awareness strategies to ensure earlier diagnosis for central tumours and young people is crucial to minimise brain injury, subsequent disability and late effects of treatment for 70% of survivors.
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Affiliation(s)
| | - Jo-Fen Liu
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Laura Murphy
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Sophie Wilne
- Paediatric Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David Walker
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
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30
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Hayden J, Murray MJ, Bartels U, Ajithkumar T, Muthusamy B, Penn A, Calaminus G, Nicholson J. Symptom interval and treatment burden for patients with malignant central nervous system germ cell tumours. Arch Dis Child 2020; 105:247-252. [PMID: 31594777 DOI: 10.1136/archdischild-2019-317245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Patients with central nervous system germ cell tumours (CNS-GCTs) commonly initially present to primary care or general paediatricians. Prolonged symptom intervals (SI) are frequently seen in CNS-GCTs and have been associated with inferior outcomes in other brain tumours. This study reviewed the clinical presentation of CNS-GCTs and examined the effect of prolonged SI. DESIGN/SETTING/PATIENTS/OUTCOMES International multicentre 10-year retrospective study (2002-2011 inclusive), across six international paediatric oncology treatment centres. All newly diagnosed patients with CNS-GCT were included. Main outcome measure was time interval from first symptom to diagnosis. RESULTS The study cohort included 86 (58 males:28 female) patients (59 'germinoma' and 27 'non-germinomatous' GCTs), with tumours being pineal (n=33), suprasellar (n=25), bifocal (pineal+suprasellar; n=24) and 'other' site (n=4), of which 16 (19%) were metastatic. Median age at diagnosis was 14 years (0-23 years). The time to diagnosis from first symptom (SI) was 0-69 months (median 3 months, mean 9 months). A prolonged SI (>6 months) was observed in 28/86 patients (33%) and significantly associated with metastatic disease (11/28 (39%) vs 5/58 (9%); p=0.002)) at diagnosis, but not overall survival. With prolonged SI, endocrine symptoms, particularly diabetes insipidus, were more common (21/28 (75%) vs 14/58 (24%) patients; p<0.002), but raised intracranial pressure (RICP) was less frequent (4/28 (14%) vs 43/58 (74%) patients; p<0.001)) at first symptom. CONCLUSIONS One-third of patients with CNS-GCT have >6 months of symptoms prior to diagnosis. Delayed diagnosis is associated with metastatic disease. Early symptom recognition, particularly related to visual and hormonal disturbances in the absence of RICP, may improve timely diagnosis, reduce metastatic disease frequency and consequently reduce treatment burden and late effects.
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Affiliation(s)
- James Hayden
- Department of Paediatric Haematology and Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Paediatric Haematology and Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ute Bartels
- Department of Paediatric Haematology and Oncology, Paediatric Brain Tumour Program, SickKids, Toronto, Ontario, Canada
| | - Thankamma Ajithkumar
- Department of Radiation Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Brinda Muthusamy
- Department of Paediatric Neuro-Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anthony Penn
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - James Nicholson
- Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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31
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Diagnostic delay in children with central nervous system tumors and the need to improve education. J Neurooncol 2019; 145:591-592. [PMID: 31691058 DOI: 10.1007/s11060-019-03329-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
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32
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Global burden of childhood cancer: growing, but controllable. Lancet Oncol 2019; 20:1184-1185. [PMID: 31371207 DOI: 10.1016/s1470-2045(19)30424-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022]
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33
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Gupta T, Achari R, Chatterjee A, Chen ZP, Mehta M, Bouffet E, Jalali R. Comparison of Epidemiology and Outcomes in Neuro-Oncology Between the East and the West: Challenges and Opportunities. Clin Oncol (R Coll Radiol) 2019; 31:539-548. [PMID: 31182288 DOI: 10.1016/j.clon.2019.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/24/2022]
Abstract
Although neoplasms of the brain and central nervous system (CNS) are relatively uncommon, comprising only 1-2% of the overall cancer burden, they represent a substantial source of morbidity and mortality worldwide. The age-adjusted annual incidence of CNS tumours is reportedly low; however, there is substantial global variability in its incidence, with nearly a five-fold difference between regions with the highest rates in developed countries in the West and those with the lowest rates in developing countries in South-East Asia, including India, possibly attributable to key differences in environmental factors, genetic susceptibilities and cultural practices, as well as resource constraints in low-middle income countries precluding precise ascertainment and accurate diagnosis. The burden of CNS tumours is further compounded by the fact that they require highly specialised and skilled multidisciplinary care, including access to modern neuroimaging, neurosurgery, neuropathology and molecular biology, radiotherapy, chemotherapy and rehabilitation services, which may not be widely available in an integrated manner in large parts of the world with a large variation in clinical pathways, non-uniformity of care and resultant heterogeneity in clinical outcomes. CNS tumours encompass a heterogeneous spectrum of histopathological entities with differences in presentation, distinct molecular/genetic alterations, diverse biological behaviour and varying clinical outcomes. Survival is highly dependent on histology, grade and molecular biology, but varies widely across continents, even for the same tumour type and grade. In general, survival is higher in children with primary brain tumours than in adults, largely due to the differences in histological distribution across age groups. However, there is widespread variability, with 5-year survival for paediatric brain tumours being <40% in some low-middle income countries compared with 70-80% in the developed world. This review compares the descriptive epidemiology and clinical outcomes of primary brain tumours between the East and the West that pose unique challenges but also provide new opportunities in contemporary neuro-oncological practice.
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Affiliation(s)
- T Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.
| | - R Achari
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, India
| | - A Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Z-P Chen
- Department of Neurosurgery, SunYat-sen University Cancer Centre, Guangzhou, China
| | - M Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - E Bouffet
- Neuro-Oncology Section, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - R Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, India
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Patel V, McNinch NL, Rush S. Diagnostic delay and morbidity of central nervous system tumors in children and young adults: a pediatric hospital experience. J Neurooncol 2019; 143:297-304. [DOI: 10.1007/s11060-019-03160-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/25/2019] [Indexed: 12/24/2022]
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Scott SE, Penfold C, Saji S, Curtis S, Watts C, Hamilton W, Joannides AJ, Walter FM. 'It was nothing that you would think was anything': Qualitative analysis of appraisal and help seeking preceding brain cancer diagnosis. PLoS One 2019; 14:e0213599. [PMID: 30901334 PMCID: PMC6430370 DOI: 10.1371/journal.pone.0213599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
Background The patient’s interpretation of the events and decisions leading up to consultation with a healthcare professional for symptoms of brain cancer is under researched. The aim of this study was to document responses to noticing the changes preceding a diagnosis of brain cancer and living with them, focusing on appraisal of changes and the decision to seek (and re-seek) help, with attention to the psychological processes underpinning the appraisal and help-seeking intervals. Method In this qualitative study set in Eastern and NW England, in-depth interviews with adult patients recently diagnosed with primary brain cancer and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework. Results 39 adult patients were interviewed. Regarding the appraisal interval, cognitive heuristics were found to underpin explanations of changes/symptoms. The subtlety and normality of changes often suggested nothing serious was wrong. Common explanations included stress or being busy at work, or age and these did not seem to warrant a visit to a doctor. Explanations and the decision to seek help were made within the social context, with friends, family and work colleagues contributing to appraisal and help-seeking decisions. Regarding the help-seeking interval, barriers to seeking help reflected components of Social Cognitive Theory, and included having other priorities, outcome expectations (e.g. ‘feeling silly’, not sure much can be done about it, not wanting to waste doctors’ time) and accessibility of a preferred healthcare professional. Conclusion Application of psychological theory facilitated understanding of the influences on cognition and behaviour. The study highlights implications for theory, awareness campaigns and potential opportunities promoting more timely help-seeking.
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Affiliation(s)
- Suzanne E. Scott
- Centre for Oral, Clinical & Translational Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Guy’s Hospital, London, United Kingdom
- * E-mail:
| | - Clarissa Penfold
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Smiji Saji
- Clinical School, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Curtis
- Centre for Oral, Clinical & Translational Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Willie Hamilton
- Willie Hamilton, St Luke’s Campus, University of Exeter, Exeter, United Kingdom
| | - Alexis J. Joannides
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Fiona M. Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
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Lam CG, Howard SC, Bouffet E, Pritchard-Jones K. Science and health for all children with cancer. Science 2019; 363:1182-1186. [DOI: 10.1126/science.aaw4892] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Each year ~429,000 children and adolescents aged 0 to 19 years are expected to develop cancer. Five-year survival rates exceed 80% for the 45,000 children with cancer in high-income countries (HICs) but are less than 30% for the 384,000 children in lower-middle-income countries (LMICs). Improved survival rates in HICs have been achieved through multidisciplinary care and research, with treatment regimens using mostly generic medicines and optimized risk stratification. Children’s outcomes in LMICs can be improved through global collaborative partnerships that help local leaders adapt effective treatments to local resources and clinical needs, as well as address common problems such as delayed diagnosis and treatment abandonment. Together, these approaches may bring within reach the global survival target recently set by the World Health Organization: 60% survival for all children with cancer by 2030.
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Stiller CA, Bayne AM, Chakrabarty A, Kenny T, Chumas P. Incidence of childhood CNS tumours in Britain and variation in rates by definition of malignant behaviour: population-based study. BMC Cancer 2019; 19:139. [PMID: 30744596 PMCID: PMC6371471 DOI: 10.1186/s12885-019-5344-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/01/2019] [Indexed: 11/26/2022] Open
Abstract
Background Intracranial and intraspinal tumours are the most numerous solid tumours in children. Some recently defined subtypes are relatively frequent in childhood. Many cancer registries routinely ascertain CNS tumours of all behaviours, while others only cover malignant neoplasms. Some behaviour codes have changed between revisions of the International Classification of Diseases for Oncology, including pilocytic astrocytoma, downgraded to uncertain behaviour in ICD-O-3. Methods We used data from the population-based National Registry of Childhood Tumours, which routinely included non-malignant CNS tumours, to document the occurrence of CNS tumours among children aged < 15 years in Great Britain during 2001–2010 and to document the descriptive epidemiology of childhood CNS tumours over the 40-year period 1971–2010, during which several new entities were accommodated in successive editions of the WHO Classification and revisions of ICD-O. Eligible cases were all those with a diagnosis included in Groups III (CNS tumours) and Xa (CNS germ-cell tumours) of the International Classification of Childhood Cancer, Third Edition. The population at risk was derived from annual mid-year estimates by sex and single year of age compiled by the Office for National Statistics and its predecessors. Incidence rates were calculated for age groups 0, 1–4, 5–9 and 10–14 years, and age-standardised rates were calculated using the weights of the world standard population. Results Age-standardised incidence in 2001–10 was 40.1 per million. Astrocytomas accounted for 41%, embryonal tumours for 17%, other gliomas for 10%, ependymomas for 7%, rarer subtypes for 20% and unspecified tumours for 5%. Incidence of tumours classified as malignant and non-malignant by ICD-O-3 increased by 30 and 137% respectively between 1971-75 and 2006–10. Conclusions Total incidence was similar to that in other large western countries. Deficits of some, predominantly low-grade, tumours or differences in their age distribution compared with the United States and Nordic countries are compatible with delayed diagnosis. Complete registration regardless of tumour behaviour is essential for assessing burden of disease and changes over time. This is particularly important for pilocytic astrocytoma, because of its recent downgrading to non-malignant and time trends in the proportion of astrocytomas with specified subtype.
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Affiliation(s)
- Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, 4150 Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK.
| | - Anita M Bayne
- National Cancer Registration and Analysis Service, Public Health England, 4150 Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK
| | | | - Tom Kenny
- Faculty of Health & Social Sciences, University of Bournemouth, Bournemouth, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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Boutahar FZ, Benmilou S, Kababri ME, Kili A, Khorassani ME, Allali N, Khattab M, Qaddoumi I, Hessissen L. Time to diagnosis of pediatric brain tumors: a report from the Pediatric Hematology and Oncology Center in Rabat, Morocco. Childs Nerv Syst 2018; 34:2431-2440. [PMID: 30054805 PMCID: PMC7685949 DOI: 10.1007/s00381-018-3927-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Delayed diagnosis of pediatric brain tumors is known to occur worldwide but is not well studied in developing countries. Here, we examined the extent of delayed pediatric brain tumor diagnoses in Rabat, Morocco, and consider its potential causes and possible solutions. METHODS We conducted a survey and interviews of the parents of children who were admitted to the Department of Hematology and Pediatric Oncology of Rabat Children's Hospital from January 1, 2016 to June 30, 2016. RESULTS The families of 27 patients (14 girls and 13 boys) participated in the survey and interview. The median patient age was 7 years (range, 1-15 years). The most common presenting symptoms were vomiting (n = 18) and headache (n = 17). The tumor locations were supratentorial in 13 cases and infratentorial in 14 cases. The median time to diagnosis was 2 months (range, 0.25-20 months). The longest times to diagnosis occurred in children older than 5 years and in patients with supratentorial tumors or low-grade glioma. We did not observe any differences in the time to diagnosis according to sex, socioeconomic status, or urban or rural origin. CONCLUSIONS Delayed diagnosis of pediatric brain tumors is a universal problem, evidenced by many studies in different countries. We propose that a paradigm shift in medical curricula addressing the delayed diagnosis of pediatric brain tumors should occur in medical schools and clinical training programs.
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Affiliation(s)
| | - Sarra Benmilou
- Department of Pediatric Oncology, University Hassan II Fès, Fez, Morocco
| | - Maria El Kababri
- Pediatric Hematology and Oncology Center, University Mohamed V Rabat, Rabat, Morocco
| | - Amina Kili
- Pediatric Hematology and Oncology Center, University Mohamed V Rabat, Rabat, Morocco
| | - Mohamed El Khorassani
- Pediatric Hematology and Oncology Center, University Mohamed V Rabat, Rabat, Morocco
| | - Nazik Allali
- Department of Pediatric Radiology, University Mohamed V Rabat, Rabat, Morocco
| | - Mohamed Khattab
- Pediatric Hematology and Oncology Center, University Mohamed V Rabat, Rabat, Morocco
| | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Laila Hessissen
- Pediatric Hematology and Oncology Center, University Mohamed V Rabat, Ibn Rochd Avenue, 6542, Rabat, BP, Morocco.
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Sadighi Z, Curtis E, Zabrowksi J, Billups C, Gajjar A, Khan R, Qaddoumi I. Neurologic impairments from pediatric low-grade glioma by tumor location and timing of diagnosis. Pediatr Blood Cancer 2018; 65:e27063. [PMID: 29741274 PMCID: PMC6310055 DOI: 10.1002/pbc.27063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND The neurologic outcomes of low-grade gliomas (LGGs) according to tumor location and duration of presenting symptoms remain poorly characterized in children. PROCEDURE We retrospectively reviewed neurologic impairments in 246 pediatric patients with LGGs (88 with optic pathway and midline tumors, 56 with posterior fossa tumors, 52 with cerebral hemisphere tumors, 35 with brainstem tumors, and 15 with spinal cord tumors) who were treated at St. Jude Children's Research Hospital between 1995 and 2005. We compared neurologic impairments (defined by Common Terminology Criteria for Adverse Events, version 4.03) by tumor location and prediagnosis symptom interval (PSI) (≥ 3 months or < 3 months) at first and last patient visits. RESULTS The median age of diagnosis was 7.1 years; median PSI was 2.1 months; and median time to last follow-up was 11.6 years. LGGs in the cerebral hemispheres resulted in significantly fewer neurologic impairments, compared with that of other locations at baseline (P < 0.001) and at last follow-up (P < 0.001). In all patients, PSIs greater than 3 months resulted in a significantly higher incidence of ataxia and dysmetria at last follow-up (42%, P = 0.003). Greater PSI was also significantly associated with worsening lower extremity motor weakness from cerebral hemisphere tumors; dysmetria from optic pathway and midline tumors; eye and visual dysfunction from posterior fossa tumors; and ear and vestibular disturbances from brainstem tumors (P ≤ 0.05). CONCLUSION Neurologic impairment in pediatric LGGs varies by tumor location, and PSIs greater than 3 months affect some functionally important neurologic outcomes.
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Affiliation(s)
- Zsila Sadighi
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Elizabeth Curtis
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jennifer Zabrowksi
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Catherine Billups
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Raja Khan
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
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Aljuhani SH, Bamaroof SA, Alghamdi TH, Almogbel AA, Alkhammash AS, Alkhammash BS, Bahusayn AA, Bangash MH, Baeesa SS, Chaudhary AG, Abuzenadah AM, Mirza AA, Saka MY, Hussein DM. Public awareness of central nervous system tumors in the Kingdom of Saudi Arabia. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2018; 23:227-237. [PMID: 30007999 PMCID: PMC8015579 DOI: 10.17712/nsj.2018.3.20180055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/14/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate individuals` knowledge about central nervous system tumors (CNST) signs and symptoms and risk factors, as well as their readiness to seek medical advice. The signs and symptoms associated with CNSTs are often vague, and failure to recognize them could lead to delays in seeking help and possibly fatal results. METHODS This was a cross-sectional survey that utilized 2 delivery methods. A total of 1,500 personally delivered and 1,500 online self-administered questionnaires were completed in parallel between June 2015 and June 2016 for the occupants of the Kingdom of Saudi Arabia. RESULTS Significant differences were observed for the sociodemographic characteristics of participants recruited via the 2 methods. The most recognized symptom was "Headaches" (45.2%), and the most recognized risk factor was "Radioactive location/occupation" (84.1%). Overall knowledge scores were low, significantly predicted by employment and cancer contact (p<0.05), while the scores significantly higher for participants who were willing to see their doctors within a week (p<0.005). The most recognized barrier to seeking help was "Worry about what the doctor might find" (74.0%). CONCLUSION The level of awareness of CNSTs was low. Using a questionnaire delivered in 2 different ways enabled the recruitment of sample pools with different sociodemographic characteristics.
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Affiliation(s)
- Shahad H. Aljuhani
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Saja A. Bamaroof
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Thoraya H. Alghamdi
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Alhanoof A. Almogbel
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Alhanof S. Alkhammash
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Batool S. Alkhammash
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Amjad A. Bahusayn
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohamad H. Bangash
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Saleh S. Baeesa
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Adeel G. Chaudhary
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Adel M. Abuzenadah
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed A. Mirza
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohamad Y. Saka
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Deema M. Hussein
- From the Faculty of Applied Medical Sciences (Aljuhani, Bamaroof, Alghamdi, Almogbel, Alkhammash A, Alkhammash B, Bahusayn, Chaudhary, Abuzenadah, Mirza), Division of Neurosurgery (Bangash, Baeesa), Center of Excellence in Genomic Medicine Research (Chaudhary), and from King Fahd Medical Research Center (Abuzenadah, Saka, Hussein), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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Coven SL, Stanek JR, Hollingsworth E, Finlay JL. Delays in diagnosis for children with newly diagnosed central nervous system tumors. Neurooncol Pract 2018; 5:227-233. [PMID: 31386013 DOI: 10.1093/nop/npy002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background United States studies documenting time interval from symptom onset to definitive diagnosis for childhood central nervous system (CNS) tumors are more than a quarter-century old. The purpose of this study is to establish an accurate and contemporary Ohio baseline of the diagnostic interval for children with newly diagnosed CNS tumors. Methods Medical records were retrospectively reviewed for 301 children with newly diagnosed CNS tumors from January 2004 to August 2015 at Nationwide Children's Hospital. We obtained comprehensive data on 171 patients (56.8%). Records were reviewed for age, gender, tumor type, presenting symptoms, number of health care visits prior to diagnosis, time interval (in months) from onset of symptoms to definitive diagnosis, and any associated genetic syndromes. Results Of the 171 patients with newly diagnosed CNS tumors, 25 children (14.6%) had a known cancer predisposition syndrome (all with neurofibromatosis type 1). Among the remaining 146 children, the median and mean time intervals from symptom onset to definitive diagnosis were 42 days and 138 days (range < 1 to 2190 days), respectively. Conclusions We have documented and quantified the contemporary delays in diagnosis of childhood brain tumors in central Ohio to serve as a benchmark for our future planned interventions to reduce the time interval from symptom onset to diagnosis through adaptation of the United Kingdom HeadSmart program throughout the state of Ohio and ultimately throughout the United States.
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Affiliation(s)
- Scott L Coven
- The Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Joseph R Stanek
- The Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Ethan Hollingsworth
- The Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Jonathan L Finlay
- The Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
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de Rojas T, Bautista F, Flores M, Igual L, Rubio R, Bardón E, Navarro L, Murillo L, Hladun R, Cañete A, Garcia-Ariza M, Garrido C, Fernández-Teijeiro A, Quiroga E, Calvo C, Llort A, de Prada I, Madero L, Cruz O, Moreno L. Management and outcome of children and adolescents with non-medulloblastoma CNS embryonal tumors in Spain: room for improvement in standards of care. J Neurooncol 2017; 137:205-213. [PMID: 29248974 DOI: 10.1007/s11060-017-2713-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/11/2017] [Indexed: 02/07/2023]
Abstract
Non-medulloblastoma CNS embryonal tumors (former PNET/Pineoblastomas) are aggressive malignancies with poor outcome that have been historically treated with medulloblastoma protocols. The purpose of this study is to present a tumor-specific, real-world data cohort of patients with CNS-PNET/PB to analyze quality indicators that can be implemented to improve the outcome of these patients. Patients 0-21 years with CNS-PNET treated in eight large institutions were included. Baseline characteristics, treatment and outcome [progression-free and overall survival (PFS and OS respectively)] were analyzed. From 2005 to 2014, 43 patients fulfilled entry criteria. Median age at diagnosis was 3.6 years (range 0.0-14.7). Histology was pineoblastoma (9%), ependymoblastoma (5%), ETANTR (7%) and PNET (77%). Median duration of the main symptom was 2 weeks (range 0-12). At diagnosis, 28% presented with metastatic disease. Seventeen different protocols were used on frontline treatment; 44% had gross total resection, 42% craniospinal radiotherapy, 86% chemotherapy, and 33% autologous hematopoietic stem cell transplantation (aHSCT). Median follow-up for survivors was 3.5 years (range 1.7-9.3). 3-year PFS was 31.9% (95% CI 17-47%) and OS 35.1% (95% CI 20-50%). Age, extent of resection and radiotherapy were prognostic of PFS and OS in univariate analysis (p < 0.05). Our series shows a dismal outcome for CNS-PNET, especially when compared to patients included in clinical trials. Establishing a common national strategy, implementing referral circuits and collaboration networks, and incorporating new molecular knowledge into routine clinical practice are accessible measures that can improve the outcome of these patients.
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Affiliation(s)
- Teresa de Rojas
- Pediatric Oncology Department, Hospital Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Francisco Bautista
- Pediatric Oncology Department, Hospital Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Miguel Flores
- Pediatric Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lucía Igual
- Pediatric Oncology Department, Hospital La Fe, Valencia, Spain
| | - Raquel Rubio
- Pediatric Oncology Department, Hospital Cruces, Bilbao, Spain
| | - Eduardo Bardón
- Pediatric Oncology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Lucía Navarro
- Pediatric Oncology Department, Hospital Virgen del Rocío, Sevilla, Spain
| | - Laura Murillo
- Pediatric Oncology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Raquel Hladun
- Pediatric Oncology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Adela Cañete
- Pediatric Oncology Department, Hospital La Fe, Valencia, Spain
| | | | - Carmen Garrido
- Pediatric Oncology Department, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eduardo Quiroga
- Pediatric Oncology Department, Hospital Virgen del Rocío, Sevilla, Spain
| | - Carlota Calvo
- Pediatric Oncology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Anna Llort
- Pediatric Oncology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Luis Madero
- Pediatric Oncology Department, Hospital Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Ofelia Cruz
- Pediatric Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lucas Moreno
- Pediatric Oncology Department, Hospital Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain. .,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.
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Azizi AA, Heßler K, Leiss U, Grylli C, Chocholous M, Peyrl A, Gojo J, Slavc I. From Symptom to Diagnosis-The Prediagnostic Symptomatic Interval of Pediatric Central Nervous System Tumors in Austria. Pediatr Neurol 2017; 76:27-36. [PMID: 28935367 DOI: 10.1016/j.pediatrneurol.2017.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Children with central nervous system (CNS) tumours may present with a multitude of symptoms, ranging from elevated intracranial pressure to focal neurological deficit. In everyday practice, some signs may be misleading, thereby causing prolonged prediagnostic symptomatic intervals. Prediagnostic symptomatic intervals are longer for pediatric brain tumors than for other childhood malignancies. This study evaluated prediagnostic symptomatic intervals and parental and diagnostic intervals for pediatric patients with CNS tumours in Austria. It also considered socioeconomic factors. METHODS Patients ≤ 19 years of age treated at the Medical University of Vienna and diagnosed during the years 2008 to 2013 were included. Patients diagnosed incidentally or by screening were excluded. RESULTS Two hundred twelve consecutive patients were included in the study. They reflected the expected spectrum of CNS tumors. Patients presented with a median of five symptoms at diagnosis, most frequently with signs of elevated intracranial pressure. The median prediagnostic symptomatic interval was 60 days (0 days to seven years), the median parental interval was 30 days (0 days to 6.7 years), and the median diagnostic interval was three days (0 days to 6.5 years). In spinal tumors alone (n = 7), the median prediagnostic symptomatic interval was 70 days (ten days to seven years), and three of seven patients had a prediagnostic symptomatic interval longer than 320 days. Young age, higher tumor grade, and ataxia were associated with a shorter prediagnostic symptomatic interval. Localization in the supratentorial midline, histology of craniopharyngioma, and endocrine symptoms prolonged the prediagnostic symptomatic interval. There was a clear trend for longer prediagnostic symptomatic interval in non-native speakers. CONCLUSIONS Results are comparable to other industrialized countries. However, long delays in diagnosis of central nervous system tumors still occur, urging increased awareness.
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Affiliation(s)
- Amedeo A Azizi
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
| | - Kirsten Heßler
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ulrike Leiss
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Chryssa Grylli
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Monika Chocholous
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Peyrl
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Gojo
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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44
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Goldman RD, Cheng S, Cochrane DD. Improving diagnosis of pediatric central nervous system tumours: aiming for early detection. CMAJ 2017; 189:E459-E463. [PMID: 27895146 DOI: 10.1503/cmaj.160074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ran D Goldman
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics (Goldman), Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics (Cheng), and Division of Pediatric Neurosurgery, Department of Surgery (Cochrane), BC Children's Hospital, Vancouver, BC; Child and Family Research Institute (Goldman, Cheng, Cochrane), University of British Columbia, Vancouver, BC
| | - Sylvia Cheng
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics (Goldman), Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics (Cheng), and Division of Pediatric Neurosurgery, Department of Surgery (Cochrane), BC Children's Hospital, Vancouver, BC; Child and Family Research Institute (Goldman, Cheng, Cochrane), University of British Columbia, Vancouver, BC
| | - D Douglas Cochrane
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics (Goldman), Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics (Cheng), and Division of Pediatric Neurosurgery, Department of Surgery (Cochrane), BC Children's Hospital, Vancouver, BC; Child and Family Research Institute (Goldman, Cheng, Cochrane), University of British Columbia, Vancouver, BC
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45
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Abstract
Much time, effort and investment goes into the diagnosis of symptomatic cancer, with the expectation that this approach brings clinical benefits. This investment of resources has been particularly noticeable in the UK, which has, for several years, appeared near the bottom of international league tables for cancer survival in economically developed countries. In this Review, we examine expedited diagnosis of cancer from four perspectives. The first relates to the potential for clinical benefits of expedited diagnosis of symptomatic cancer. Limited evidence from clinical trials is available, but the considerable observational evidence suggests benefits can be obtained from this approach. The second perspective considers how expedited diagnosis can be achieved. We concentrate on data from the UK, where extensive awareness campaigns have been conducted, and initiatives in the primary-care setting, including clinical decision support, have all occurred during a period of considerable national policy change. The third section considers the most appropriate patients for cancer investigations, and the possible community settings for identification of such patients; UK national guidance for selection of patients for investigation is discussed. Finally, the health economics of expedited diagnosis are reviewed, although few studies provide definitive evidence on this topic.
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Affiliation(s)
- Willie Hamilton
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - Fiona M Walter
- Department of Public Health &Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Greg Rubin
- School of Medicine, Pharmacy and Health, Wolfson Building, Queen's Campus, University of Durham, Stockton-on-Tees TS17 6BH, UK
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Gwenfro Unit 5, Wrexham Technology Park, Wrexham LL13 7YP, UK
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46
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Vassal G, Fitzgerald E, Schrappe M, Arnold F, Kowalczyk J, Walker D, Hjorth L, Riccardi R, Kienesberger A, Jones KP, Valsecchi MG, Janic D, Hasle H, Kearns P, Petrarulo G, Florindi F, Essiaf S, Ladenstein R. Challenges for children and adolescents with cancer in Europe: the SIOP-Europe agenda. Pediatr Blood Cancer 2014; 61:1551-7. [PMID: 24706509 PMCID: PMC4285788 DOI: 10.1002/pbc.25044] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 03/03/2014] [Indexed: 12/24/2022]
Abstract
In Europe, 6,000 young people die of cancer yearly, the commonest disease causing death beyond the age of 1 year. In addition, 300,000-500,000 European citizens are survivors of a childhood cancer and up to 30% of them have severe long-term sequelae of their treatment. Increasing both cure and quality of cure are the two goals of the European paediatric haematology/oncology community. SIOPE coordinates and facilitates research, care and training which are implemented by the 18 European study groups and 23 national paediatric haematology/oncology societies. SIOPE is the European branch of the International Society of Paediatric Oncology and one of the six founding members of the European Cancer Organisation. SIOPE is preparing its strategic agenda to assure long-term sustainability of clinical and translational research in paediatric malignancies over the next 15 years. SIOPE tackles the issues of equal access to standard care and research across Europe and improvement of long term follow up. SIOPE defined a comprehensive syllabus for training European specialists. A strong partnership with parent, patient and survivor organisations is being developed to successfully achieve the goals of this patient-centred agenda. SIOPE is advocating in the field of EU policies, such as the Clinical Trials Regulation and the Paediatric Medicine Regulation, to warrant that the voice of young people is heard and their needs adequately addressed. SIOPE and the European community are entirely committed to the global agenda against childhood cancers to overcome the challenges to increasing both cure and quality of cure of young people with cancer.
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Affiliation(s)
- Gilles Vassal
- Direction of Clinical Research, Gustave Roussy and Université Paris-SudVillejuif, France
| | | | - Martin Schrappe
- University Medical Centre Schleswig-Holstein, Campus KielKiel, Germany
| | - Frédéric Arnold
- Union Nationale des Associations de Parents d'Enfants atteints de Cancer ou Leucémie (Unapecle)Montpellier, France
- International Confederation of Childhood Cancer Parent Organizations (ICCPO)Nieuwegein, The Netherlands
| | - Jerzy Kowalczyk
- Department of Paediatric Haematology Oncology and Transplantology, Medical UniversityLublin, Poland
| | - David Walker
- Children's Brain Tumour Research Centre, Faculty of Medicine and Health Sciences, University of NottinghamNottingham, United Kingdom
| | - Lars Hjorth
- Department of Paediatrics, Skåne University Hospital, Clinical Sciences, Lund UniversityLund, Sweden
| | - Riccardo Riccardi
- Division of Paediatric Oncology, Policlinico Universitario “A. Gemelli”Roma, Italy
| | - Anita Kienesberger
- International Confederation of Childhood Cancer Parent Organizations (ICCPO)Nieuwegein, The Netherlands
| | | | - Maria Grazia Valsecchi
- Centre of Biostatistics for Clinical Epidemiology, Department of Health Science, University of Milano-BicoccaMonza, Italy
| | - Dragana Janic
- School of Medicine, University of Belgrade, and University Children's HospitalBelgrade, Serbia
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital SkejbyAarhus, Denmark
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of BirminghamBirmingham, United Kingdom
| | | | | | | | - Ruth Ladenstein
- Children's Cancer Research Institute, St. Anna Kinderkrebsforschung e.V., Children's Cancer Research InstituteWien, Austria
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