LINC-16. Factors Associated with Delayed Diagnosis Among Filipino Pediatric Brain Tumor Patients: A Retrospective Review

Abstract

BACKGROUND: Delayed diagnosis is observed greatest among pediatric brain tumors compared to other childhood malignancies. Several factors have been found to influence delay. OBJECTIVE: To determine delayed diagnosis measured by the prediagnostic symptomatic interval (PSI) among Filipino pediatric brain tumor patients and identify associated factors. METHODS: Data was collected retrospectively on pediatric brain tumor patients of Philippine General Hospital from 2015-2019. PSI was calculated. Demographic and clinical data were presented using descriptive statistics. Bivariate and linear regression analyses were used to determine factors. RESULTS: The median overall PSI was 80.5days. The median interval from symptom onset to first physician consult was 22days. The median interval from first consult to subspecialty referral was 23.5days. Majority presented with 2 symptoms at onset (42.3%) and during first physician consult (36.2%). Upon subspecialist referral, 52% have ≥4 symptoms. Most patients (68.4%) consulted with a pediatrician. Most were diagnosed with another condition prior to brain tumor diagnosis. Longer PSI was significantly associated with older age (p=0.005), tumor location (p=0.009), tumor grade (p<0.001), and more physicians consulted prior to subspecialist referral (p=0.001). Significant predictors of delayed diagnosis were supratentorial tumors (4-month delay, p=0.014), and those presenting with seizures (11-month delay, p=0.002), poor school performance (1-year delay, p=0.008), behavioral changes (1.3-year delay, p=0.033), and secondary amenorrhea (3-year delay, p=0.021). Predictors of earlier brain tumor diagnosis include posterior fossa tumors (p=0.041), malignant tumors (p=0.002), and vomiting (p=0.020). CONCLUSION: Delayed diagnosis among Filipino brain tumor patients is associated with age, tumor characteristics and symptoms that are uncommon in this condition. This emphasizes the need for first contact physicians to be aware about these symptoms, and keep a diagnosis of brain tumor as a differential. This, coupled with a detailed history, accurate neurologic examination and early subspecialist referral may lead to earlier diagnosis and treatment for pediatric brain tumor patients.