Multicentre service evaluation of presentation of newly diagnosed cancers and type 1 diabetes in children in the UK during the COVID-19 pandemic

  1. Gemma Williams
  2. Ross McLean
  3. Jo-Fen Liu
  4. Timothy A Ritzmann
  5. Madhumita Dandapani
  6. Dhurgshaarna Shanmugavadivel
  7. Pooja Sachdev
  8. Mark Brougham
  9. Rod T Mitchell
  10. Nicholas T Conway
  11. James Law
  12. Alice Cunnington
  13. Gbemi Ogunnaike
  14. Karen Brougham
  15. Elizabeth Bayman
  16. David Walker

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Abstract

The COVID-19 pandemic led to changes in patterns of presentation to emergency departments. Child health professionals were concerned that this could contribute to the delayed diagnosis of life-threatening conditions, including childhood cancer (CC) and type 1 diabetes (T1DM). Our multicentre, UK-based service evaluation assessed diagnostic intervals and disease severity for these conditions.

Methods

We collected presentation route, timing and disease severity for children with newly diagnosed CC in three principal treatment centres and T1DM in four centres between 1 January and 31 July 2020 and the corresponding period in 2019. Total diagnostic interval (TDI), patient interval (PI), system interval (SI) and disease severity across different time periods were compared.

Results

For CCs and T1DM, the route to diagnosis and severity of illness at presentation were unchanged across all time periods. Diagnostic intervals for CCs during lockdown were comparable to that in 2019 (TDI 4.6, PI 1.1 and SI 2.1 weeks), except for an increased PI in January–March 2020 (median 2.7 weeks). Diagnostic intervals for T1DM during lockdown were similar to that in 2019 (TDI 16 vs 15 and PI 14 vs 14 days), except for an increased PI in January–March 2020 (median 21 days).

Conclusions

There is no evidence of diagnostic delay or increased illness severity for CC or T1DM, during the first phase of the pandemic across the participating centres. This provides reassuring data for children and families with these life-changing conditions.

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  1. Version published to 10.1136/bmjpo-2021-001078
  2. ScreenIT

    SciScore for 10.1101/2021.02.09.21251149: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableOf these, 164 (64%) were male and 55 (22%) were from a BAME background.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed with IBM SPSS 26.0 for Windows (IBM Corp. Armonk, NY, USA) and p<0.05 was considered statistically significant.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are a number of limitations to this study. Only four centres in the UK were involved, therefore the presentation. study Whilst lacked the the analysis ability was to detect prospectively national variations designed, the data in patterns collection of was retrospective. We cannot exclude the possibility of incomplete areas of data collection given that some of the children in the service evaluation will have been treated in more than one centre. We believe that this effect is both random and minimal across the centres. Given the resources available for this service evaluation we elected to collect comparison data for one year prior to the pandemic (2019). However, we recognise that fluctuation occurs and a longer period of pre-pandemic data collection would have provided greater insight into this variation. It was reassuring however that the incident cases of CC across the UK as a whole remained stable from 2013-17 22 . In view of the fluid situation of the pandemic, data collection was completed in July 2020 as we believed that timely presentation could inform local practice. We will continue data collection to account for the diagnostic lag for specific diseases including brain tumours. Data collection at a more comprehensive national level would also provide greater clarity on diagnostic intervals. Furthermore, it is important to establish whether subsequent public health measures have impacted the TDI in the context of an evolving backlog of patient referrals across...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.02.09.21251149v2 on medRxiv
  4. Version published to 10.1101/2021.02.09.21251149v1 on medRxiv