Diagnostic delay and survival in high-grade gliomas - evidence of the 'waiting time paradox'?

British Journal of Neurosurgery
Ajay AggarwalJeremy Rees

Abstract

We present a retrospective single-centre study to determine whether delays in diagnosis of high-grade glioma (HGG) impact on overall survival (OS). Consecutive patients diagnosed with HGG at a single neuroscience centre in 2011 were reviewed. Route of referral and time from initial presentation to diagnosis were analysed and correlated with OS. 118 patients were studied - 92 patients with glioblastoma (GBM). Diagnosis of GBM in patients presenting to emergency services was quicker than that through outpatients (8 days vs. 26 days, p < 0.0001), but these patients had significantly worse OS (181 days vs. 386 days p = 0.0075). This trend was observed for the whole cohort (Grade III and GBM), with OS 278 days in patients presenting to emergency services compared with 423 days for patients presenting via outpatients (p = 0.0034). Patients presenting to outpatients were younger (median age: 54 years) compared with patients presenting to emergency services (median age: 62.5 years) (p = 0.0106). There were no other differences between the two groups with respect to the nature of presenting symptoms. Earlier diagnosis is paradoxically associated with a worse OS in GBM. An 'aggressive' phenotype with rapid symptomatic deterioration and h...Continue Reading

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Citations

Jun 13, 2017·International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society·Mette Calundann NoerClaus Høgdall
Feb 11, 2018·British Journal of Neurosurgery·Michael KosminNaomi Fersht
Aug 2, 2019·Journal of Medical Imaging and Radiation Oncology·Tristan B ShawBenjamin Chua
Oct 9, 2019·Nature Communications·Holly J ButlerMatthew J Baker
Mar 12, 2020·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Koji HirataAkira Matsumura
Oct 28, 2019·PloS One·José Luis Lopez-CedrúnPablo Varela-Centelles
Feb 25, 2021·International Journal of Technology Assessment in Health Care·Ewan GrayMatthew J Baker
Jun 1, 2021·Neuro-oncology Advances·Domenique M J MüllerPhilip C De Witt Hamer

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