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The development and initial evaluation of referral flowchart for suspected neuroblastoma for pediatricians in nononcology clinics in China
Author(s) -
Ma Xiaoli,
Duan Chao,
Cai Siyu,
Wang Xindi,
Jiang Chiyi,
Yue Zhixia,
Li Kun,
Jin Mei,
Zhang Dawei,
Wang Xiaoman,
Peng Xiaoxia
Publication year - 2021
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28869
Subject(s) - medicine , referral , pediatrics , vanillylmandelic acid , neuroblastoma , family medicine , homovanillic acid , receptor , biology , serotonin , genetics , cell culture
Background The delayed diagnosis of neuroblastoma (NB) is common in China, which results in the prognosis of NB in China lagging behind that in developed countries. Methods A referral flowchart for suspected NB was implemented in nononcology clinics at Beijing Children's Hospital (BCH). Patients with symptoms of suspected NB were referred from nononcology clinics in BCH to oncology clinics and confirmed NB cases were regarded as referral group. The control group comprised patients initially diagnosed with NB who came directly to oncology clinics in BCH from other regions nationwide. The age at NB diagnosis was compared as primary outcome, and the 5‐year overall survival (OS) and event‐free survival (EFS) were compared via the Kaplan‐Meier method and log‐rank tests. Results In total, 3337 children with suspected NB were screened consecutively from 687 070 pediatric patients. Through examination of urine vanillylmandelic acid and homovanillic acid, or B‐ultrasound, 102 of 3337 patients were referred to oncologists for comprehensive evaluations. Eventually, 29 referred patients were diagnosed as NB and the hospital‐based diagnosis rate of NB was 4.2 per 100 000 visits. The median age at diagnosis in the referral group was 21.0 months, which was 9 months earlier than that of the control group (30.0 months, P = .026). The 5‐year OS rate was 72.4% in the referral group, which was higher than that of the control group (66.7%) but without statistical significance ( P = .664). Conclusion Delayed NB detection could be avoided by training pediatricians in nononcology clinics to detect suspected NB and refer these patients to oncologists.