Abstract
Introduction: Clinical presentations of childhood leukaemia have been reported in case-only studies. The timing when these presentations start to occur prior to diagnosis is less clear. Methods: In this nested case–control study, 1,025 and 334 children with lymphoid and myeloid leukaemia, respectively, were matched (1:30) to population-based controls by sex, region and year of birth. An index date was assigned for each control when the matched case was diagnosed. Healthcare access records of cases and controls in the year before the index date were extracted. Results: Children with lymphoid leukaemia started to visit doctors more often at least 2 months before leukaemia diagnosis (P < 0.05). Various presentations were recorded in these visits: rates of haematological presentations, musculoskeletal presentations, and injuries started to increase significantly at least 3 months before diagnosis; rates of respiratory, gastrointestinal and urinary tract presentations did not increase significantly until the last month. The findings for myeloid lymphoma were less clear, but children appeared to visit doctors more often at least 4 months before diagnosis, and the rate of haematological presentations also started to increase at least 4 months before leukaemia diagnosis. Although haematological presentations were most strongly associated with undiagnosed leukaemia (odds ratio > 290 in the last month), the majority (>96%) of children with haematological presentations did not have leukaemia if they had not been diagnosed in their first visit. Conclusions: We described a clinical picture in the year before leukaemia diagnosis. These findings revealed ongoing difficulties in early diagnosis of childhood leukaemia in healthcare settings.
| Original language | English |
|---|---|
| Pages (from-to) | 1387-1393 |
| Number of pages | 7 |
| Journal | Pediatric Blood and Cancer |
| Volume | 63 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 1 2016 |
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Keywords
- cancer screening
- childhood leukaemia
- early diagnosis
- electronic health record
- epidemiology
- personalised medicine
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Medicine(all)
- Hematology
- Oncology
Cite this
Specific and Non-specific Clinical Presentations in the Year Before the Diagnosis of Childhood Leukaemia. / Yang, Tien Yu Owen; Liu, Yen Lin; Huang, Wan Ting; Chen, Mei Huei; Chen, Pau Chung.
In: Pediatric Blood and Cancer, Vol. 63, No. 8, 01.08.2016, p. 1387-1393.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Specific and Non-specific Clinical Presentations in the Year Before the Diagnosis of Childhood Leukaemia
AU - Yang, Tien Yu Owen
AU - Liu, Yen Lin
AU - Huang, Wan Ting
AU - Chen, Mei Huei
AU - Chen, Pau Chung
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Introduction: Clinical presentations of childhood leukaemia have been reported in case-only studies. The timing when these presentations start to occur prior to diagnosis is less clear. Methods: In this nested case–control study, 1,025 and 334 children with lymphoid and myeloid leukaemia, respectively, were matched (1:30) to population-based controls by sex, region and year of birth. An index date was assigned for each control when the matched case was diagnosed. Healthcare access records of cases and controls in the year before the index date were extracted. Results: Children with lymphoid leukaemia started to visit doctors more often at least 2 months before leukaemia diagnosis (P < 0.05). Various presentations were recorded in these visits: rates of haematological presentations, musculoskeletal presentations, and injuries started to increase significantly at least 3 months before diagnosis; rates of respiratory, gastrointestinal and urinary tract presentations did not increase significantly until the last month. The findings for myeloid lymphoma were less clear, but children appeared to visit doctors more often at least 4 months before diagnosis, and the rate of haematological presentations also started to increase at least 4 months before leukaemia diagnosis. Although haematological presentations were most strongly associated with undiagnosed leukaemia (odds ratio > 290 in the last month), the majority (>96%) of children with haematological presentations did not have leukaemia if they had not been diagnosed in their first visit. Conclusions: We described a clinical picture in the year before leukaemia diagnosis. These findings revealed ongoing difficulties in early diagnosis of childhood leukaemia in healthcare settings.
AB - Introduction: Clinical presentations of childhood leukaemia have been reported in case-only studies. The timing when these presentations start to occur prior to diagnosis is less clear. Methods: In this nested case–control study, 1,025 and 334 children with lymphoid and myeloid leukaemia, respectively, were matched (1:30) to population-based controls by sex, region and year of birth. An index date was assigned for each control when the matched case was diagnosed. Healthcare access records of cases and controls in the year before the index date were extracted. Results: Children with lymphoid leukaemia started to visit doctors more often at least 2 months before leukaemia diagnosis (P < 0.05). Various presentations were recorded in these visits: rates of haematological presentations, musculoskeletal presentations, and injuries started to increase significantly at least 3 months before diagnosis; rates of respiratory, gastrointestinal and urinary tract presentations did not increase significantly until the last month. The findings for myeloid lymphoma were less clear, but children appeared to visit doctors more often at least 4 months before diagnosis, and the rate of haematological presentations also started to increase at least 4 months before leukaemia diagnosis. Although haematological presentations were most strongly associated with undiagnosed leukaemia (odds ratio > 290 in the last month), the majority (>96%) of children with haematological presentations did not have leukaemia if they had not been diagnosed in their first visit. Conclusions: We described a clinical picture in the year before leukaemia diagnosis. These findings revealed ongoing difficulties in early diagnosis of childhood leukaemia in healthcare settings.
KW - cancer screening
KW - childhood leukaemia
KW - early diagnosis
KW - electronic health record
KW - epidemiology
KW - personalised medicine
UR - http://www.scopus.com/inward/record.url?scp=84976483823&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84976483823&partnerID=8YFLogxK
U2 - 10.1002/pbc.26029
DO - 10.1002/pbc.26029
M3 - Article
C2 - 27128206
AN - SCOPUS:84976483823
VL - 63
SP - 1387
EP - 1393
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
SN - 1545-5009
IS - 8
ER -