Diagnostic delay and survival in high-grade gliomas - evidence of the 'waiting time paradox'?
BACKGROUND
We present a retrospective single-centre study to determine whether delays in diagnosis of high-grade glioma (HGG) impact on overall survival (OS).


METHODS
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.


RESULTS
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.


CONCLUSIONS
Earlier diagnosis is paradoxically associated with a worse OS in GBM. An 'aggressive' phenotype with rapid symptomatic deterioration and hence emergency presentation is a poor prognostic factor not influenced by earlier diagnosis.
a National Hospital for Neurology and Neurosurgery , Queen Square, London , UK.
Ajay
A
Aggarwal
Naomi
N
Herz
Philip
P
Campbell
Leo
L
Arkush
Susan
S
Short
Jeremy
J
Rees
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D057210:Delayed Diagnosis; D004632:Emergency Medical Services; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000401:mortality; D005910:Glioma / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
diagnostic delay; glioblastoma; high-grade glioma; routes to diagnosis; survival