Abstract

Research Article

Factors associated with diagnostic delay in children with Wilms’ tumor

Adauto Dutra Moraes Barbosa*, Francisca Norma Gutierrez, Guilherme de Aguiar Moraes, Marilia Fornaciari Grabois and Sima Ester Ferman

Published: 15 April, 2021 | Volume 4 - Issue 1 | Pages: 042-045

Background: In Wilms’ tumor, the time elapsed between clinical diagnosis and the start of treatment is clearly associated with morbidity and mortality. As treatment delay can influence patient survival, identification of possible causes can mitigate the consequences arising from prolonged diagnostic uncertainty.

Objective: To ascertain whether an initial diagnosis of Wilms’ tumor in the emergency department influences patient prognosis depending on the type of referral for definitive treatment.

Patients and methods: Retrospective chart review of 98 children receiving treatment for Wilms’ tumor at the Brazilian National Cancer Institute (INCA) between April 2003 and December 2016. Patients were categorized into two groups: those referred directly from an emergency public department to INCA and those first transferred to another hospital before being referred to INCA.

Results: Of the 98 cases included in the study, 42.9% were direct referrals and 57.1% were indirect referrals. Presence of an abdominal mass was the most common presenting complaint, followed by abdominal pain. In cases with larger tumors, the mean tumor volume was greater than reported elsewhere in the literature, suggesting longer disease duration. Significantly higher tumor volumes were observed in patients with a palpable abdominal mass as compared to those with the second most frequent complaint (abdominal pain).

Conclusion: The findings of this study support the hypothesis that patients diagnosed with kidney masses in the emergency department are at greater risk of delayed diagnosis when they are referred first to a non-specialized outside hospital than when referred directly to a specialized cancer treatment unit.

Read Full Article HTML DOI: 10.29328/journal.japch.1001030 Cite this Article Read Full Article PDF

Keywords:

Wilms’ tumor; Child; Delayed diagnosis

References

  1. Loh AHP, Aung L, Ha C, Tan AM, Quah TC, et al. Diagnostic delay in pediatric solid tumors: A population based study on determinants and impact on outcomes. Pediatr Blood Cancer. 2012; 58: 561-565. PubMed: https://pubmed.ncbi.nlm.nih.gov/22052842/
  2. Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: A systematic review. Lancet. 1999; 353: 1119-1126. PubMed: https://pubmed.ncbi.nlm.nih.gov/10209974/
  3. Austoker J, Bankhead C, Forbes LJL, Atkins L, Martin F, et al. Interventions to promote cancer awareness and early presentation: Systematic review. Br J Cancer. 2009; 101 (Suppl 2): S31–S39. PubMed: https://pubmed.ncbi.nlm.nih.gov/19956160/
  4. Elliss-Brookes L, McPhail S, Ives A, Greenslade M, Shelton J, et al. Routes to diagnosis for cancer - Determining the Patient Journey Using Multiple Routine Data Sets. Br J Cancer. 2012; 107: 1220-1226. PubMed: https://pubmed.ncbi.nlm.nih.gov/22996611/
  5. Dang-Tan T, Trottier H, Mery LS, Morrison HI, Barr RD, et al. Delays in diagnosis and treatment among children and adolescents with cancer in Canada. Pediatr Blood Cancer. 2008; 51: 468-474. PubMed: https://pubmed.ncbi.nlm.nih.gov/18454472/
  6. Hol JA, Lopez-Yurda MI, Van Tinteren H, Van Grotel M, Godzinski J, et al. Prognostic significance of age in 5631 patients with Wilms tumour prospectively registered in International Society of Paediatric Oncology (SIOP) 93-01 and 2001. PLoS ONE. 2019; 14: e0221373. PubMed: https://pubmed.ncbi.nlm.nih.gov/31425556/
  7. Dang-Tan T, Franco EL. Diagnosis delays in childhood cancer: A review. Cancer. 2007; 110: 703-713. PubMed: https://pubmed.ncbi.nlm.nih.gov/17620277/
  8. Fajardo-Gutiérrez A, Sandoval-Mex AM, Mejía-Aranguré JM, Rendón-Macías ME, Martínez-García MC. Clinical and social factors that affect the time to diagnosis of Mexican children with cancer. Med Pediatr Oncol. 2002; 39: 25–31. Pubmed: https://pubmed.ncbi.nlm.nih.gov/12116075/
  9. Haimi M, Peretz Nahum M, Ben Arush MW. Delay in diagnosis of children with cancer: A retrospective study of 315 children. Pediatr Hematol Oncol. 2004; 21: 37-48. PubMed: https://pubmed.ncbi.nlm.nih.gov/14660305/
  10. Hansen RP, Olesen F, Sørensen HT, Sokolowski I, Søndergaard J. Socioeconomic patient characteristics predict delay in cancer diagnosis: A Danish cohort study. BMC Health Serv Res. 2008; 8: 49. PubMed: https://pubmed.ncbi.nlm.nih.gov/18307790/
  11. Brasme JF, Morfouace M, Grill J, Martinot A, Amalberti R, et al. Delays in diagnosis of paediatric cancers: a systematic review and comparation with expert testimony in lawsuits. Lancet Oncol. 2012; 13: e445-59. PubMed: https://pubmed.ncbi.nlm.nih.gov/23026830/
  12. Delahunt B, Bethwaite PB, Nacey JN, Lewis ME, Fraser J. Wilms’ Tumour in New Zealand 1960-1986. Br J Urol. 1992; 70: 663-668. PubMed: https://pubmed.ncbi.nlm.nih.gov/1336698/
  13. Pollock BH, Krischer JP, Vietti TJ. Interval between symptom onset and diagnosis of pediatric solid tumors. J Pediatr. 1991; 119: 725-732. PubMed: https://pubmed.ncbi.nlm.nih.gov/1941378/
  14. Thulesius H, Pola J, Håkansson A. Diagnostic Delay in Pediatric Malignancies: A Population based Study. Acta Oncol. 2000; 39: 873-876. PubMed: https://pubmed.ncbi.nlm.nih.gov/11145447/
  15. Seminara C, Planells MC, Pogonza RE, Morales M. Wilms tumor: 15 years of experience at a children’s hospital in Córdoba, Argentina. Arch Argent Pediatr. 2019; 117: 263-266. PubMed: https://pubmed.ncbi.nlm.nih.gov/31339273/
  16. Saha V, Love S, Eden T, Micallef-Eynaud P, MacKinlay G. Determinants of Symptom Interval in Childhood Cancer. Arch Dis Child. 1993; 68: 771-774. PubMed: https://pubmed.ncbi.nlm.nih.gov/8333770/
  17. Haimi M, Perez-Nahum M, Stein N, Ben Arush MW. The role of the doctor and the medical system in the diagnostic delay in pediatric malignancies. Cancer Epidemiol. 2011; 35: 83-89. PubMed: https://pubmed.ncbi.nlm.nih.gov/20685192/

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