EPID-08. FINDING THE NEEDLE IN THE HAY STACK – POPULATION-BASED STUDY OF PREDIAGNOSTIC SYMPTOMATIC INTERVAL IN CHILDREN WITH CNS TUMORS

Abstract PURPOSE Delay in diagnosis of central nervous system (CNS) tumors in children is well documented. The aims of this study were to characterize the symptomatology of CNS tumors and the time to diagnosis in a large pediatric hospital in Canada. METHODS Retrospective chart review of children diagnosed with a CNS tumor between 2000 and 2016 in Vancouver, British Columbia, Canada was performed. Data collected included demographics, symptomatology, tumor type, age at diagnosis, known visits to healthcare professionals, neuroimaging, therapy and post treatment relapse or progression. RESULTS 148 children with complete medical records were reviewed. The average age at diagnosis was 87.8 months (standard deviation (SD) = 59.7; median = 72). 50.7% of patients had posterior fossa tumors and 49.3% had supratentorial tumors. 30% of patients were diagnosed after a single visit to a health care provider. 7.7% of children needed more than 4 visits. Median total time to diagnosis (PSI) was 62 days (range = 0-2047 days). The longest prediagnostic interval was first symptom onset to first healthcare provider visit (PSI1, median 37 days). Patients with posterior fossa tumors, presence of metastases, and symptoms of ataxia and paresis were associated with shorter PSI. CONCLUSIONS CNS tumors in children continue to pose a diagnostic challenge with significant variability in time to diagnosis. Our population-based study found that median time from symptoms to seeking medical advice by parents was over a month. It is essential to uncover the reasons for delay and address them where possible.

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Long-Term Neuromotor Speech Deficits in Survivors of Childhood Posterior Fossa Tumors: Effects of Tumor Type, Radiation, Age at Diagnosis, and Survival Years

Journal of Child Neurology ◽

10.1177/0883073807303995 ◽

2007 ◽

Vol 22 (7) ◽

pp. 848-854 ◽

Cited By ~ 35

Author(s):

Joelene F. Huber ◽

Kim Bradley ◽

Brenda Spiegler ◽

Maureen Dennis

Keyword(s):

Posterior Fossa ◽

Age At Diagnosis ◽

Tumor Type ◽

Posterior Fossa Tumors

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Prevalence, Age at Diagnosis, Mortality, and Cause of Death in Retinitis Pigmentosa in Korea—A Nationwide Population-based Study

American Journal of Ophthalmology ◽

10.1016/j.ajo.2017.01.014 ◽

2017 ◽

Vol 176 ◽

pp. 157-165 ◽

Cited By ~ 8

Author(s):

Kun-Hoo Na ◽

Hyun Jung Kim ◽

Kyoung Hoon Kim ◽

Seungjin Han ◽

Patrick Kim ◽

...

Keyword(s):

Retinitis Pigmentosa ◽

Cause Of Death ◽

Population Based ◽

Age At Diagnosis ◽

Population Based Study

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Asthma remission by age at diagnosis and gender in a population-based study

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2020.12.015 ◽

2020 ◽

Author(s):

Jasmin Honkamäki ◽

Päivi Piirilä ◽

Hanna Hisinger-Mölkänen ◽

Leena E. Tuomisto ◽

Heidi Andersen ◽

...

Keyword(s):

Population Based ◽

Age At Diagnosis ◽

Population Based Study ◽

And Gender

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EPID-13. A POPULATION-BASED ANALYSIS OF CNS TUMOR DIAGNOSES, TREATMENT, AND SURVIVAL IN CONGENITAL AND INFANT AGE GROUPS

Neuro-Oncology ◽

10.1093/neuonc/noaa222.199 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii321-iii321

Author(s):

Muriel Hart ◽

Amy Mellies ◽

Alina Beltrami ◽

Ahmed Gilani ◽

Adam Green

Keyword(s):

Age Groups ◽

Young Patients ◽

High Grade Glioma ◽

Population Based ◽

Cns Tumors ◽

Low Grade ◽

Tumor Type ◽

Older Children ◽

Embryonal Tumors ◽

Chi Square

Abstract BACKGROUND Congenital (<3 months) and infant (3 to 11 months) brain tumors are biologically different from tumors in older children, but epidemiology of these tumors has not been studied comprehensively. Insight into epidemiological differences could help tailor treatment recommendations by age and increase overall survival (OS). METHODS Population-based data from the SEER 18 registries was obtained for 14,493 0-19-year-olds diagnosed with CNS tumors between 1990 and 2015. Incidence, treatment, and survival were analyzed using Chi-square and Kaplan-Meier analyses. RESULTS Between the <3 month, 3–5 month, 6–11 month, and 1–19 year age groups, tumor type distribution differed significantly (p<0.001); high-grade glioma (HGG) was most common in the <3-month-olds, while low-grade glioma (LGG) was most common in the other groups. 5-year OS for all tumors was 36.7% (<3 months), 56.0% (<3–5 months), 63.8% (6–11 months), and 74.7% (1–19 years) (log rank p<0.001). OS by tumor type was worst for <3-month-olds with LGG, medulloblastoma, and other embryonal tumors; OS was worst for 3-5-month-olds with ependymoma, <1-year-olds collectively with atypical teratoid-rhabdoid tumor, and 1-19-year-olds with HGG (log rank p<0.02 for all tumor types). <3-month-olds were least likely to receive any treatment for each tumor type and least likely to undergo surgery for all except HGG. <1-year-olds were far less likely than 1-19-year-olds to undergo radiation for embryonal tumors, as expected, but were also less likely to undergo chemotherapy. CONCLUSIONS Congenital/infant CNS tumors differ pathologically, therapeutically, and prognostically from those in older children. Treatment changes could help address poorer outcomes for these young patients.

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Improved Prognosis in Multiple Myeloma-a Population Based Study on 13,376 Patients Diagnosed in Sweden 1973–2001.

Blood ◽

10.1182/blood.v104.11.2408.2408 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2408-2408

Author(s):

Sigurdur Y. Kristinsson ◽

Ola Landgren ◽

Paul Dickman ◽

Asa Derolf ◽

Magnus Bjorkholm

Keyword(s):

Multiple Myeloma ◽

Excess Mortality ◽

Relative Survival ◽

Population Based ◽

Age At Diagnosis ◽

University Hospital ◽

Calendar Period ◽

Population Based Study ◽

Younger Age ◽

One Year

Abstract Background: Over the last decades there have been advances in the treatment of patients with multiple myeloma (MM) and prognosis has improved with the introduction of new treatment strategies. However, few studies have addressed the issue which patients benefit most from these therapeutic changes over the years. Aims: To evaluate relative survival in all diagnosed MM patients in Sweden 1973–2001 and relate the changes to age, sex and type of hospital where diagnosis was made. Methods: All patients with MM notified to the Swedish Cancer Register in 1973–2001 were followed up by record linkage to the nationwide Cause of Death Register. Survival analyses were performed by obtaining relative survival (RS) defined as the ratio of observed versus expected survival. The study period was divided arbitrarily to four calendar periods: 1973–1979, 1980–1986, 1987–1993, and 1994–2002. Patients were grouped according to age at diagnosis (0–40, 41–50, 51–60, 61–70, 71–80, and 80+), sex, and hospital category. RS was estimated using SAS (Cary, NC, USA) and excess mortality modelled using Poisson regression. Results: A total of 13,376 patients (7,114 males and 6,262 females, mean age 69.8 years, and 32% diagnosed at a university hospital) were diagnosed with MM in Sweden between January 1st 1973 and December 31st 2001. The overall one-year RS estimates were 73%, 78%, 80%, and 81%, respectively, for the four calendar periods. The overall five-year RS was 31%, 32%, 34%, and 36% and the ten-year RS remained stable at 12%, 11% 13% in the first three periods; ten-year RS could not be calculated for the last calendar period. The increase in one-year RS was observed in all age categories over the four calendar periods, while the increase in five-year RS was restricted to patients <70 years. Younger age at onset was associated with a superior survival in all calendar periods. Differences in survival by age at diagnosis and calendar period were highly statistically significant (p<0.0001). Females had a superior 1- (p=0.002), 5- (p=0.024), and 10-year RS (p=0.019) compared to males, after adjusting for age and period. Patients diagnosed at university hospitals had superior 5- and 10-year RS (p=0.007) but not 1-year RS. Summary/conclusions: The present study shows an improved prognosis over time in a population-based study including > 13,000 MM patients diagnosed during a 29-year period. Of interest is that even one-year RS has improved in all age groups over the whole study period. Increase in five-year RS was only observed in patients aged <70 years. The ten-year RS did not improve over the first 20 years and could not be estimated for patients diagnosed in the last period. Younger age at diagnosis was associated with superior one-, five- and ten-year RS in all calendar periods. Females had a significantly better survival than males. A significant difference in survival was seen according to type of hospital, with patients diagnosed at a university hospital surviving longer. In conclusion, the results show that survival of MM patients has improved during the study period. However, long-term survival has not improved significantly. Males, elderly patients and patients diagnosed during early calendar periods experienced higher excess mortality.

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Effect of age at diagnosis of breast cancer on the patterns and risk of mortality from all causes: A population-based study in Australia

Asia-Pacific Journal of Clinical Oncology ◽

10.1111/j.1743-7563.2012.01567.x ◽

2012 ◽

Vol 9 (2) ◽

pp. 129-138 ◽

Cited By ~ 2

Author(s):

Geoffrey Francis Beadle ◽

Nicole Jean McCarthy ◽

Peter David Baade

Keyword(s):

Breast Cancer ◽

Population Based ◽

Age At Diagnosis ◽

Population Based Study ◽

Risk Of Mortality ◽

Effect Of Age

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OS2.1 Incidence patterns for primary spinal cord ependymomas in adults: a Surveillance, Epidemiology, and End Results study

Neuro-Oncology ◽

10.1093/neuonc/noz126.021 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii7-iii7

Author(s):

W Man ◽

G Wang

Keyword(s):

Spinal Cord ◽

Population Based ◽

Incidence Rates ◽

Adult Patients ◽

Age At Diagnosis ◽

Tumor Type ◽

Seer Database ◽

Histological Subtype ◽

Over Time ◽

End Results

Abstract BACKGROUND Ependymomas are the most common primary spinal cord tumors in adults. However, few population-based studies analyzed the epidemiological features for this tumor type. We explored Surveillance, Epidemiology, and End Results (SEER) database to evaluate the incidence patterns over time with regard to patient gender, race, age at diagnosis, and histological subtype for patients diagnosed with primary malignant spinal cord gliomas between 1973 and 2015. METHODS We queried SEER database to identify all adult patients (≥ 20 years of age) diagnosed with primary spinal cord ependymomas during 1973–2015. Variables of interest included gender, race, age at diagnosis, and histological subtype of tumor. The SEER*Stat 8.3.5 program was used to calculate frequencies, age-adjusted incidence rates (IR) with adjustment to the 2000 US Standard population and 95% confidence intervals (CI). An annual percentage change (APC) statistic with a 2-sided p-values was used to assess incidence patterns over time. RESULTS 1224 adult patients with primary spinal cord ependymomas were diagnosed between 1973 and 2015. Of the total population, 55.7% were males (n = 682) and 44.3% were females (n=542). Myxopapillary ependymomas (ICD-O-3 code 9394), papillary ependymomas (9393), ependymomas (9391) and anaplastic ependymomas (9392) accounts for 28.7% (n = 351), 0.5% (n = 6), 69.4% (n = 849) and 1.5% (n = 18) respectively. The overall age-adjusted IR for all adult primary spinal cord ependymomas was 0.16 per 100,000 (95%CI 0.15–0.17). The IR in male was higher than that in female (males 0.19 per 100,000 [95% CI 0.17–0.20], females 0.14 per 100,000 [95% CI 0.13–0.14]. Caucasians experienced higher IR (0.18 per 100,000 [95% CI 0.17–0.19]) compared to African Americans (0.19 per 100,000 [95% CI 0.07–0.12]) and the others (0.10 per 100,000 [95% CI 0.08–0.13]). Patients of age between 40 and 49 years experienced the highest IR (0.25 per 100,000 [95% CI 0.22–0.29]) than patients in the other age ranges. The most common histological subtypes were ependymomas (0.11 per 100,000 [95% CI 0.11–0.12]) and myxopapillary ependymomas (0.047 per 100,000 [95% CI 0.042–0.052]. The overall age-adjusted IR for all adult primary spinal cord ependymomas showed a statistically significant increase over time between 1973 and 2015 (APC=5.15, p<0.01). The same increasing trend was found in Caucasians (APC=5.36, p<0.01) and in both males (APC=5.13, p<0.01) and females (APC=4.95, p<0.01). CONCLUSION This study demonstrates an increasing IR of adult primary spinal cord ependymomas over the past four decades. Males, Caucasians and age between 40 and 49 years experienced a higher IR.

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