G256(P) The Time to Diagnosis of all Childhood Cancers Presenting to a Paediatric Oncology Shared Care Unit

Abstract

Aims Time to diagnosis (TTD) in childhood cancer varies between tumour types. Most early diagnosis research in the United Kingdom has a predominant focus on brain tumours and tertiary centre populations. Few studies focus on the referral pathway and TTD of multiple cancer types within a defined geographical region. Methods This population based retrospective cohort study was set in a large level 2 Paediatric Oncology Shared Care Unit. Data was collected on 86 childhood cancer cases diagnosed during a 6 year period (January 2007 – December 2013). 13 cases were excluded and data was obtained from all other notes accessible to the authors with a total of 57 cases included for analysis. Different tumour types were compared to recent ADC case review data (May 2013). Time to presentation (TTP) was defined as time from initial symptoms to time seen by secondary paediatrics. Time to diagnosis (TTD) was defined as time from initial symptoms to diagnosis at primary treatment centre. Results The overall median TTD for all cancers was 33 days. Wilms’ tumour demonstrated the shortest median TTP and TTD, 4.5 days and 15.5 days respectively. Leukaemia also had a short median TTP and TTD of 14.5 days and 18 days respectively. Brain tumours, as described in previous studies, had longer median TTP and TTD of 21 and 32 days respectively. Solid tumours as a group had median TTP and TTD of 15 and 43.5 days respectively. Lymphoma had the longest delay in diagnosis with TTP 70.5 days and TTD 66.5 days respectively. Pathways to diagnosis via other specialities or private referral had longer delays. Conclusion TTP and TTD times in this study population are comparable to previous European and North American studies. However, this case set demonstrated a shorter median delay to brain tumour diagnosis and longer delay to lymphoma diagnosis. Most presentations were via immediate GP referral or self-referral to the emergency department. Only 2 cases in 6 years were referred via the 2 week pathway, challenging its relevance. Immediate referral without delay can improve service quality in the shared care setting and ultimately shortens the pathway to cancer diagnosis and treatment.

Presentation of childhood cancers to a paediatric shared care unit

“…A pilot study with a subset of 57 patients from this population has been presented previously 15. The authors would like to thank Rosie Chisnell, CNS for all her support.…”