Shortening the symptom interval in children with a suspected brain tumour

The Pathways Project, funded by SDBTT was carried out by the Children’s Brain Tumour Research Centre (CBTRC) in collaboration with the Children’s Cancer and Leukaemia Group (CCLG) at the Universities of Nottingham and Leicester, respectively.  It aimed to provide health professionals with the much needed guidance in order to shorten the time between symptoms appearing and the diagnosis of a brain tumour – which can be up to 2-3 times longer in the UK than in North America, Poland, Israel and Switzerland.

Previous research has shown that the longer the symptom interval, the greater the risk of life-threatening and disabling complications during initial treatment, with potentially poorer subsequent psychological well-being and quality of life.

Up till now referral guidelines for doctors have not focussed on symptoms specific to children. Once a tumour is suspected, diagnosis is straightforward either through MRI or CT scan.  However, unfortunately in the UK there has been a reluctance in practice to perform such scans early. 

The key symptoms for children of any age include impaired movement, nausea and/or vomiting, seizures and visual disturbance.  Symptoms in children may present in many different ways, and those under 3 years may show different symptoms to older children. If a child has had a persistent headache or lethargy for 4 weeks or has had any of the other symptoms for 2 weeks they should be given a thorough examination with neurological and visual assessment.  If these assessments indicate a brain tumour is likely the child should be sent for a scan immediately.

The research consulted over 150 healthcare professionals in order to produce a number of guidelines which the Nottingham team hope will provide the basis for future Government policy.

The Pathways Project research has been presented to National Institute for Health and Clinical Excellence (NICE) and will now be sent to the Royal College of Paediatrics and Child Health as well as the Royal College of General Practitioners

Notes

• The Pathways Project, funded by SDBTT was carried out by the Children’s Brain Tumour Research Centre (CBTRC) in collaboration with the Children’s Cancer and Leukaemia Group (CCLG) at the Universities of Nottingham and Leicester, respectively.
• Symptoms can be divided into 2 groups: Intracranial pressure - headache + vomiting especially on rising, swelling behind the eyes; tumour location – weak limbs disturbed vision, epilepsy, difficulty swallowing, co-ordination
• The research uses the Delphi Consensus process to validate timescales for referral
• The research team included Prof Sophie Wilne, Prof Jacqueline Collier, Prof Richard Grundy, Mr Jonathan Punt, Prof Colin Kennedy, Dr Karin  Koller