Introduction
Brain tumours in India account for 8-12% of all childhood cancers as compared to 21% in the West 1,2. Despite the rise in incidence over the past few years, reported incidence of CNS tumours in India are still just half of that in the developed world3. Many factors attribute to this presumed low incidence of brain tumours. These include incorrect diagnosis, inequality to access healthcare services and treatment abandonment. Delayed diagnosis and poor awareness are also massive barriers to the management and treatment of paediatric brain cancers. With a 5-year survival rate as low as 26.8%, early detection and treatment is key to improving outcomes for children with brain tumours4. Delayed diagnosis is associated with a higher risk of life-threatening and disabling neurological complications at presentation and a poor cognitive outcome amongst survivors 5-10. We have initiated a collaborative project, aiming to reduce the diagnostic interval experienced by children diagnosed with brain tumours by enhancing the awareness of symptoms that are indicative of brain tumours in children and young people. This report focuses on the pathways and time to diagnosis of childhood CNS tumours in Tamil Nadu and compares this to existing data in developed countries using similar definitions of specific time intervals.
A patient interval (PI) is defined as the period between the first presentation of symptoms and the first notification to any health-care professional 11. Longer PIs are linked to an increased risk of severe neurological complications upon presentation, as well as worse cognitive outcomes among survivors 12. Moreover, longer PIs have adverse consequences on the child and the family’s psychological well-being, as well as upon professional relationships12. A System interval (SI) is the period between the patients first notification to any HPC and the time they get diagnosed13. Total Diagnostic Interval (TDI) is defined as the period between first presentation of symptoms until diagnosis13. TDI is also defined as the sum of PI and SI. TDI = PI + SI.