Brain Tumor Signs and Symptoms: Analysis of Primary Health Care Records From the UKCCS

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Good information on symptom clusters seen in secondary care at the time of brain tumor diagnosis is now available, but information on how children present in primary care is poor and subject to recall bias. WHAT THIS STUDY ADDS:This report describes signs and symptoms recorded in children's general practitioner (primary health care) records between birth and brain tumor diagnosis and for the first time, compares rates of attendance and reasons for consultation with those of unaffected children. RESULTS:On average, cases consulted more often than controls between birth and diagnosis/pseudodiagnosis with brain tumor signs and symptoms. Their consultation rate with Ն1 suggestive symptom escalated in the 2 years before diagnosis. Symptom prevalence was higher among cases than controls, a relative difference of 3.29 times as many consultations with Ն1 suggestive symptom (95% confidence interval [CI]: 2.82-3.83) and 7.01 as many with more than 1 (95% CI: 5.38 -9.13). In each 6-month period in the 4 years before diagnosis, cases had at least twice as many consultations with Ն1 suggestive symptom (20.81 times as many in the 6 months before diagnosis ) and 2-3 times more records of suggestive symptoms (28.35 times more in the 6 months before diagnosis ). Symptoms rarely or not observed among control children included head tilt, odd head movements, odd posture, back or neck stiffness, and unsteadiness without obvious cause.CONCLUSION Key to identifying the 1 child among many who merits prompt investigation is recognition of unusual symptoms, or specific symptom patterns.

Features of childhood cancer in primary care: a population-based nested case-control study

“…Increased primary care consultation rates have been reported in children diagnosed with brain tumours up to 6 months before diagnosis (Ansell et al, 2010). Our data are also consistent with the observation that parents will continue to return to their GP because their instinct is that their child 'is not right' although they may be unable to identify a specific problem (Dixon-Woods et al, 2001).…”

Interval between onset of symptoms and diagnosis of medulloblastoma in children: distribution and determinants in a population-based study

“…The indications for brain imaging could be expanded to the children with nonspecific symptom that persist for more than a month, or a combination, even nonspecific, of symptoms, or a significant neurological sign or symptom (such as ataxia), as suggested by the Children's Brain Tumour Research Centre [41], even if the specificity of such a strategy would probably be low, given the frequency of these symptoms in the general population [1,3].…”

“…The principal explanation is the lack of specificity of the symptoms [3,8,11,14,16,30,35,39,41], often ordinary and wrongly attributed to common conditions (for example, vomiting attributed to gastro-oesophageal reflux), or considered psychological in origin [9]. Existing studies of the time to diagnosis of brain tumours in children and their determinants are of limited value for understanding the specific issues of medulloblastomas, for they group together several types of tumours, different in histology and site [3,8,11,16,25,30,35] and include a fairly small number of medulloblastoma [8,11,16,25,30,35], or are based on recruitment from a single hospital and thus subject to substantial selection bias [8,11,16,17,25,35].…”

“…Existing studies of the time to diagnosis of brain tumours in children and their determinants are of limited value for understanding the specific issues of medulloblastomas, for they group together several types of tumours, different in histology and site [3,8,11,16,25,30,35] and include a fairly small number of medulloblastoma [8,11,16,25,30,35], or are based on recruitment from a single hospital and thus subject to substantial selection bias [8,11,16,17,25,35]. Because the exact causes of diagnosis delays in medulloblastoma in children remain poorly understood, it is difficult to propose guidelines to reduce them [41].…”

A long duration of the prediagnostic symptomatic interval is not associated with an unfavourable prognosis in childhood medulloblastoma

“…[12][13][14] However, available information on the correctness of this assumption is insufficient, as studies on PSI in children with brain tumors suffer from low patient numbers, retrospective design, heterogeneity of patient, disease, and treatment characteristics, and lacking outcome data. [4][5][6][7][8][9][10][11][15][16][17][18][19][20][21][22][23][24] To study the association of the PSI with disease stage at diagnosis as well as tumor control and survival outcome, we analyzed prospectively collected data on 224 homogeneously treated patients. 3.…”