Paediatric Central Nervous System Tumours: Symptomatology and Total Diagnostic Interval in a New Zealand Cohort

Background

Central nervous system (CNS) tumours are the leading cause of paediatric oncologic death and survivors face high rates of persistent disability. Timeframe from initial symptom to diagnostic radiography [total diagnostic interval (TDI)] is associated with increased morbidity and mortality. Interventions such as HeadSmart and Brain Pathways Guidelines UK have reduced TDI in the United Kingdom through public and professional education campaigns.

Aims

The overarching aim of this project is to reduce TDI for brain tumours across New Zealand. As there are no local data for TDI in paediatric CNS tumours, we sought baseline data prior to local interventions, which would then inform interventions in the next project phase.

Methods

Retrospective analysis of patients ≤ 18 years with a CNS tumour in the CHOC catchment between 2015 and 2020. Demographics, tumour type, presenting symptoms/signs, referral pathways and TDI were recorded.

Results

Of 72 cases, median TDI was 9 weeks (0–156 weeks). This was lower in patients aged < 4 years compared with > 4 years (4 weeks vs. 13 weeks), in high grade tumours compared to low grade (4 weeks vs. 13 weeks), and in other ethnicities compared with Māori/Pasifika (6 weeks vs. 16.5 weeks) (p < 0.05 for all comparisons). Symptomatology was similar to Brain Pathways, however, some signs including head circumference were poorly recorded and identify areas for improvement.

Conclusions

Median TDI is higher than recommended targets, and there is ethnic disparity. This gives impetus for local intervention, using strategies comparable to Brain Pathways.