Evaluation of Pathway to Diagnosis of Pediatric Brain Tumors in Tamil Nadu, India

Kartik, Prerna; Liu, Jo-Fen; Sudarsan, Rishan Thimma; Srinivasan, Aarthi; Jayaraman, Dhaarani; Sivaprakasam, Ponni; John, Rikki; Uppuluri, Ramya; Scott, Julius Xavier; Jalali, Rakesh; Dandapani, Madhumita

Abstract

Purpose
Delayed diagnosis and poor awareness are significant barriers to the early intervention of pediatric brain tumors. This multicenter observational study aimed to evaluate the baseline routes and time to diagnosis for pediatric brain tumors in Tamil Nadu (TN), with the goal of promoting early diagnosis and timely referrals in the future.

Methods
A standard proforma was used to retrospectively collect information on demographics, diagnosis, referral pathways, and symptoms of incident pediatric brain tumor cases between January 2018 and October 2020 across eight tertiary hospitals in TN. Dates of symptom onset, first presentation of health care, and diagnosis were used to calculate total diagnostic interval (TDI), patient interval (PI), and diagnostic interval (DI).

Results
A total of 144 cases (mean age, 6.64 years; range, 0-15.1 years) were included in the analysis. Among those, 94% (135/144) were from city/district areas, 40% (55/144) were self-referred, and 90% (129/144) had one to three health care professional visits before diagnosis. Median TDI, PI, and DI were 3.5 (IQR, 1-9.3), 0.6 (IQR, 0.1-4.6), and 0.6 (IQR, 0-3.3) weeks, respectively. Low-grade gliomas had the longest median TDI (6.6 weeks), followed by medulloblastomas (4.6 weeks) and high-grade gliomas (3.3 weeks). Average number of symptoms recorded was 1.7 at symptom onset and 1.9 at diagnosis.

Conclusion
Although there are some similarities with data from the United Kingdom, many low-grade and optic pathway tumors were unaccounted for in our study. DIs were relatively short, which suggests that infrastructure may not be a problem in this cohort. Increased training and establishment of proper cancer registries, combined with proper referral pathways, could enhance early diagnosis for these children.

Citation

Kartik, P., Liu, J.-F., Sudarsan, R. T., Srinivasan, A., Jayaraman, D., Sivaprakasam, P., John, R., Uppuluri, R., Scott, J. X., Jalali, R., & Dandapani, M. (2024). Evaluation of Pathway to Diagnosis of Pediatric Brain Tumors in Tamil Nadu, India. JCO Global Oncology, 10(10), Article e2300214. https://doi.org/10.1200/go.23.00214

• Journal Article Type: Article
• Acceptance Date: Dec 18, 2023
• Online Publication Date: Feb 22, 2024
• Publication Date: Feb 22, 2024
• Deposit Date: Feb 23, 2024
• Publicly Available Date: Feb 23, 2024
• Journal: JCO Global Oncology
• Print ISSN: 2687-8941
• Electronic ISSN: 2687-8941
• Publisher: American Society of Clinical Oncology
• Peer Reviewed: Peer Reviewed
• Volume: 10
• Issue: 10
• Article Number: e2300214
• DOI: https://doi.org/10.1200/go.23.00214
• Keywords: Cancer Research; Oncology
• Public URL: https://nottingham-repository.worktribe.com/output/31614589
• Publisher URL: https://ascopubs.org/doi/10.1200/GO.23.00214
• Additional Information: Received: 2023-06-28; Revised: 2023-10-30; Accepted: 2023-12-18; Published: 2024-02-22