Diagnostic delay and survival in high-grade gliomas – evidence of the ‘waiting time paradox’?

Aggarwal, Ajay; Herz, Naomi; Campbell, Philip; Arkush, Leo; Short, Susan; Rees, Jeremy

doi:10.3109/02688697.2015.1012050

Cited by 19 publications

(19 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This evaluation uses estimates of the delays in diagnosis, and potential improvements in the speed of diagnosis, from a consecutive patient case series in London, UK. 5 The total volume of tests if this scenario occurred would be approximately 53 000 per year in the UK (see online supplementary appendix 4 for further details).…”

Section: Resultsmentioning

confidence: 99%

“…The primary assumptions in this model are that first, the expected time to diagnosis would match the current median time to diagnosis for patients presenting with brain tumour in emergency care as observed in Aggarwal et al ’s study. 5 Furthermore, based on expert opinion, it is assumed that in secondary care all patients would continue to imaging, while in primary care 50% would continue to imaging following a negative spectroscopy result. This is a conservative estimate associated with the possibility that an imaging test will still be required in some cases based on interpretation of a patient’s symptoms and the other non-tumour diagnoses being considered by the clinician.…”

Section: Methodsmentioning

confidence: 99%

“…4 Partly as a result of this diagnostic delay, up to 61% of brain tumour diagnoses occur in an emergency setting, often following a seizure. 5 Patients diagnosed by the emergency route have a poorer prognosis. 6 7 For some patients this may be because the disease is at a more advanced stage at diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…Timings relate to the diagnosis of high-grade gliomas and are based on discussion with the Clinical Focus Team and Aggarwal et al . 5 GP, general practitioner; MDT, multidisciplinary team; OPD, outpatient department.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Health economic evaluation of a serum-based blood test for brain tumour diagnosis: exploration of two clinical scenarios

et al. 2018

View full text Add to dashboard Cite

ObjectivesTo determine the potential costs and health benefits of a serum-based spectroscopic triage tool for brain tumours, which could be developed to reduce diagnostic delays in the current clinical pathway.DesignA model-based health pre-trial economic assessment. Decision tree models were constructed based on simplified diagnostic pathways. Models were populated with parameters identified from rapid reviews of the literature and clinical expert opinion.SettingExplored as a test in both primary and secondary care (neuroimaging) in the UK health service, as well as application to the USA.ParticipantsCalculations based on an initial cohort of 10 000 patients. In primary care, it is estimated that the volume of tests would approach 75 000 per annum. The volume of tests in secondary care is estimated at 53 000 per annum.Main outcome measuresThe primary outcome measure was quality-adjusted life-years (QALY), which were employed to derive incremental cost-effectiveness ratios (ICER) in a cost-effectiveness analysis.ResultsResults indicate that using a blood-based spectroscopic test in both scenarios has the potential to be highly cost-effective in a health technology assessment agency decision-making process, as ICERs were well below standard threshold values of £20 000–£30 000 per QALY. This test may be cost-effective in both scenarios with test sensitivities and specificities as low as 80%; however, the price of the test would need to be lower (less than approximately £40).ConclusionUse of this test as triage tool in primary care has the potential to be both more effective and cost saving for the health service. In secondary care, this test would also be deemed more effective than the current diagnostic pathway.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Health economic evaluation of a serum-based blood test for brain tumour diagnosis: exploration of two clinical scenarios

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Glioma is the most common primary malignant brain tumour in adults with an incidence of five in 100 000. About 80% are high grade (WHO III/IV) with 70% of those being glioblastoma . High‐grade glioma is difficult to treat, rapidly progresses without treatment, and is associated with poorer prognosis.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of 18F‐fluorodeoxyglucose positron emission tomography in the evaluation of glioma

et al. 2019

View full text Add to dashboard Cite

Introduction: Identifying glioma grade through imaging allows clinicians to recommend and accurately direct treatment. We sought to quantify the utility of FDG-PET/CT (18F-fluorodeoxyglucose positron emission tomography/computed tomography), alone and in combination with MRI, in identifying highgrade regions of glioma. Methods: This is a retrospective review of patients who had an FDG-PET/CT performed as part of the workup of suspected glioma or in follow-up of known glioma. FDG-PET/CT scans were reviewed and uptake in the identifiable lesion coded as none, diffusely or focally increased. Patients also underwent gadolinium-enhanced MRI, noting regions of contrast enhancement. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated for identification of high-grade histology (WHO III or IV, or metastatic disease) obtained post-FDG-PET/CT. Results: Thirty-three patients had 36 FDG-PET/CT and MRI scans followed by histological confirmation (biopsy or debulking). Increased FDG uptake demonstrated a sensitivity of 59% and specificity of 79%, PPV of 81% and NPV of 55% for identification of high-grade histology. MRI demonstrated a sensitivity of 77% and specificity of 86%, PPV of 89% and NPV of 71% for identification of highgrade histology. Only 64% of MRI and FDG-PET/CT scan series were concordant. When FDG-PET/CT and MRI were concordant, a specificity of 100% and PPV of 100% was achieved, however, sensitivity was 79% and NPV was 75%. Conclusion: The combination of FDG-PET/CT and gadolinium-enhanced MRI demonstrated marked improvement in identifying potential high-grade disease over each modality alone. Increased FDG uptake without gadolinium enhancement rarely occurred and identified high-grade histology in a small number of patients. Due to limited sensitivity and NPV, a negative FDG-PET/ CT alone, or in combination with MRI, should not guide a decision for observation where surgery would otherwise be recommended.

show abstract

Patient‐ and parent‐reported diagnostic delay in children with central nervous system tumors in Denmark

Weile,

Helligsoe,

von Holstein

et al. 2024

Pediatric Blood & Cancer

View full text Add to dashboard Cite

BackgroundDiagnostic 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.MethodsThe 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.ResultsWe 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%).ConclusionWe 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.

show abstract

Diagnostic delay and survival in high-grade gliomas – evidence of the ‘waiting time paradox’?

Abstract: Earlier diagnosis is paradoxically associated with a worse OS in GBM. An 'aggressive' phenotype with rapid symptomatic deterioration and hence emergency presentation is a poor prognostic factor not influenced by earlier diagnosis.

Cited by 19 publications

References 13 publications

Health economic evaluation of a serum-based blood test for brain tumour diagnosis: exploration of two clinical scenarios

Health economic evaluation of a serum-based blood test for brain tumour diagnosis: exploration of two clinical scenarios

Diagnostic performance of 18F‐fluorodeoxyglucose positron emission tomography in the evaluation of glioma

Patient‐ and parent‐reported diagnostic delay in children with central nervous system tumors in Denmark

Contact Info

Product

Resources

About