title: Duration of symptoms prior to diagnosis is related inversely to presenting disease stage in children with medulloblastoma.
abstract: BACKGROUND
  The authors tested the hypothesis that children with a longer duration of symptoms prior to diagnosis of medulloblastoma have more advanced disease. In addition, they evaluated whether there are correlations between gender, duration of presenting symptoms, and disease stage.
  
  
  METHODS
  The study population consisted of 122 patients with medulloblastoma who were evaluated between 1974 and 1999. The data abstracted from each chart included the date of diagnosis, date of birth, gender, race, presenting symptoms, duration of symptoms in weeks, and disease stage.
  
  
  RESULTS
  There were 70 males (57%) and 52 females (43%); 105 Caucasians (86%), 16 non-Caucasians (13%), and 1 patient of unknown race. Eighteen percent of the patients were age < or = 3 years, 59% were ages 4-16 years, and 23% were age > or = 17 years. The presenting stage was determined in 108 patients. Thirty-eight patients (35%) had high stage disease (T1-T4 M1-M4), and 70 patients (65%) had low stage disease (T1-T4 M0). The most common presenting symptoms were emesis (68%), headache (66%), nausea (40%), and ataxia (40%). The median symptom durations for patients ages 0-3 years were 4 weeks and 8 weeks for both those ages 4-16 years and those age > or = 17 years, respectively (P > 0.11). The median symptom duration for males (8 weeks) was longer than for females (5 weeks; P = 0.08). Patients with low stage disease had a median duration of symptoms (8 weeks) that was significantly greater compared with patients with high stage disease (4 weeks; P = 0.01). Relating patient age to disease stage, 47% of patients ages 0-3 years had high stage disease; 36% of patients ages 4-16 years had high stage disease; and 24% of patients age > or = 17 years had high stage disease (P = 0.20). Relating disease stage to gender, 40% of males had high stage disease compared with 28% of females (P = 0.20). Of the factors age, gender, race, and duration of symptoms, only the later was correlated significantly with disease stage at the time of presentation in both univariate and multivariate analyses.
  
  
  CONCLUSIONS
  Contrary to expectations, the duration of presenting symptoms was correlated inversely with disease state at the time of presentation. This finding has implications for lawsuits alleging that a "delay in diagnosis" leads to more advanced disease. There is weak evidence (P = 0.08) that males have a longer duration of symptoms than females. This may be related to gender-associated behavior expectations.
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA. halperin@radonc.duke.edu
authors: E C
authors: EC
authors: Halperin
authors: D M
authors: DM
authors: Watson
authors: S L
authors: SL
authors: George
mesh_terms: D000293:Adolescent; D000328:Adult; D001259:Ataxia / Q000209:etiology; D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008527:Medulloblastoma / Q000175:diagnosis / Q000473:pathology*; D009325:Nausea / Q000209:etiology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D014839:Vomiting / Q000209:etiology