Early Diagnosis

The JLA Neuro-Oncology Priority Setting Partnership (link) identified the question of “Does earlier diagnosis improve outcomes, compared with standard diagnosis times, in people with brain or spinal cord tumour?.”

This area is therefore now a priority area for clinical research.

Detecting Cancer Early (DCE); NHS England 5 year Initiative in collaboration with CRUK and the NICE and Scottish Cancer Referral Guidelines. Earlier diagnosis of brain tumour is high on the Government and brain tumour community’s agenda. The Brain Tumour Charity has issued a call for research in the area of understanding the diagnostic delays in referral and some research is currently underway in Edinburgh, Bristol and Cambridge.

Brain tumours have not been in the vanguard of cancers targeted by Government funded strategies, because they are a rare tumour, initial symptoms e.g. headache only, are very common and the likelihood of underlying tumour as a cause is remarkably low (e.g. < 1 in 1,000 under the age of 50 years or <3 in 1,000 over the age of 50 years presenting to the GP with headache.). Screening by MRI scanning may be considered costly and overuse would extend waiting times for scanning.

Previous research has shown that patients with headache from an intracranial cause, may have subtle problems with verbal fluency, memory, personality, visual field defect, or swelling of the optic discs. A CT scan should pick up most intracranial causes of headache and is cheaper and faster to obtain than an MR scan.

A protocol based referral pathway for urgent CT scanning, based on simple quick tests a GP could do in a standard visit, could be useful to diagnose these patients earlier.

The Brain Tumour Charity has issued a call for research in the area of understanding the diagnostic delays in referral and some research is currently underway in Edinburgh, Bristol and Cambridge.

The NCRI will hold an “Incubator Day” in 2016, to examine the current stage of research and advise on best design of any future study in the area. This will be lead by the NCRI Brain Clinical Studies Group and NCRI Primary Care CSG.

If interested in supporting this research area, or learning more, please contact the NCRI Brain Supportive & Palliative Care Group and leave details of your interest. (email: S&PC@neuro-oncology.org.uk)