Factors associated with delayed diagnosis among Filipino pediatric brain tumor patients: a retrospective review

Abstract

Aim: Determine delayed diagnosis measured by prediagnostic symptomatic interval (PSI) among Filipino pediatric brain tumor patients and identify associated factors. Methods: Data was collected retrospectively on Philippine General Hospital pediatric brain tumor patients from 2015 to 2019. PSI was calculated. Associated factors were determined. Results: 196 patients were included. Median PSI was 80.5 days. Longer PSI was significantly associated with older age, supratentorial and low-grade tumors, more physician consults prior to subspecialist referral, longer interval from neuroimaging request to facilitation, and those presenting with seizures (11-month delay), poor school performance (1-year delay), behavioral changes (1.3-year delay) and secondary amenorrhea (3-year delay). Conclusion: Delayed diagnosis among Filipino brain tumor patients is associated with age, tumor characteristics and symptoms that are uncommon in this condition. Awareness of these symptoms through physician education, close monitoring of patients, early subspecialist referral and better neuroimaging access may lead to earlier diagnosis.

Keywords::

• delayed diagnosis
• Filipino children
• pediatric brain tumor
• pediatric CNS tumor
• prediagnostic symptomatic interval

Author contributions

PC Orduña: conceptualized and designed the protocol, facilitated data collection and analysis and interpretation of data; drafted the work and revised it critically for important intellectual content; wrote the manuscript and contributed to the final approval of the version to be published; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CAP Lubaton-Sacro: gave substantial contributions and inputs to the conception and design of the work and interpretation of results; gave substantial contributions to revising the manuscript critically for important intellectual content; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgments

The authors acknowledge: Al Joseph R Molina, MD; The Division of Pediatric Hematology-Oncology, UP-Philippine General Hospital; Medical Social Services, UP-Philippine General Hospital.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

Ethical approval was granted by the University of the Philippines Manila Research Ethics Board (UPMREB No. 2020-633-01). A waiver of informed consent was requested from and approved by the UPMREB panel. The study was done retrospectively and involved medical records that are not publicly available and this study did not require direct patient contact. Thus, the research presented no more than minimal risk. The waiver or alteration did not adversely affect the rights and welfare of the participants. In this review of medical records, data anonymity was maintained and information sought was considered non-sensitive (Data Privacy Act of 2012), in accordance to the provisions 17.1–17.3, page 16 and 11.2, page 102 of the National Ethical Guidelines of Health and Health-related Research 2017. No follow-up of patients was done.