How Do Biological Characteristics of Primary Intracranial Tumors Affect Their Clinical Presentation in Children and Young Adults?

Abstract

We demonstrated the pattern in presentation of primary intracranial tumors in a population-based cohort of patients aged 0-24 years identified from the National Cancer Registry for England, using linked medical records from primary care and hospitals. We used generalized additive models to estimate temporal changes in presentation rates. Borderline and malignant tumors presented at a similar rate in primary care (6.4 and 6.6 consultations per 100 patients each month) and in hospital (3.4 and 3.6). Benign tumors presented earlier but less frequently (rate = 4.4 and rate ratio = 0.75, 95% CI = 0.60-0.93, in primary care; rate = 2.6 and rate ratio = 0.83, 95% CI = 0.77-0.89, in hospital). Many tumors began presenting shortly before their diagnosis, but less aggressive tumors were likely to present earlier in primary care. Earlier detection of less aggressive tumors in primary care may reduce the risk of complications and morbidity among survivors.

Does changing healthcare use signal opportunities for earlier detection of cancer? A review of studies using information from electronic patient records

“…763 studies were initially identified, of which 28 were included in the final review ( Fig. 2 ) [10] , [11] , [12] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] . All but four of the selected studies were carried out in Denmark or the UK, while the four remaining studies were set in Germany, Sweden, Australia, and the Netherlands.…”

“…There was heterogeneity between studies regarding the type of primary and secondary care consultations included. For example, regarding benign brain tumours, some studies included consultations for any symptom [11] , [31] , and some only included those for specific symptoms [20] ( Appendix 2 ), with the specific symptoms considered further varying between studies. Heterogeneity also arose from whether primary care consultations via any contact method [20] , or only face to face consultations were considered [11] , [31] .…”

“…For example, regarding benign brain tumours, some studies included consultations for any symptom [11] , [31] , and some only included those for specific symptoms [20] ( Appendix 2 ), with the specific symptoms considered further varying between studies. Heterogeneity also arose from whether primary care consultations via any contact method [20] , or only face to face consultations were considered [11] , [31] . This review did not compare diagnostic window length by contact method, as studies did not present findings by the specific method (e.g.…”

“…These studies rely on assumptions about how to define the ‘first relevant’ presentation, and achieving consistent definitions between studies is challenging, particularly in patients with morbidity who regularly consult for unrelated reasons [44] . The reviewed studies use a population approach in order to identify the earliest point at which healthcare utilisation rates change in some patients, avoiding the need for any such assumptions [20] .…”

“…The findings indicate that there is potential to harness electronic health records to inform the management of patients in practice. Electronic health records could be used to develop diagnostic “e-triggers”; these could flag patients in whom the suspicion of cancer may require monitoring or repeat assessment [12] , [15] , [20] , [35] , for example, if patients consult more frequently than usual [19] , [27] , or receive particular prescriptions e.g. for haemorrhoids [10] , which could raise suspicion of particular cancers.…”