P01 A Service Evaluation of Implementation of RCPCH Brain Pathways Clinical Guideline Linked to HeadSmart – Be Brain Tumour Aware (HeadSmart). A Health Foundation, Closing the Gap Project

Aims To evaluate the impact of the HeadSmart Campaign upon symptom interval (SI) for newly diagnosed childhood brain tumours at UK Children’s Cancer and Leukaemia Group (CCLG) treatment centres. Introduction HeadSmart’s national awareness campaign (www.headsmart.org.uk) aims to disseminate the RCPCH endorsed Brain Pathways Guideline for referral and imaging of patients with symptoms suggestive of brain tumour. Methods The SI experienced by children newly diagnosed with brain tumours was determined from January 2011 to December 2012 by HeadSmart Clinical Champions at 18 CCLG treatment centres reporting to an online database as part of a service evaluation under Caldicott guardian permission. Results Data from 353 children (median 6.7 yr, range 0.02–17.71) is available. The median SI is 7.57 weeks (mean 21.8, range 0 to 435 weeks). The median symptom onset to consultation with a healthcare professional interval is 2.3 weeks (mean 12.9, range 0 to 433 weeks), and the median consultation to diagnosis interval is 2.7 weeks (mean 9.0, range 0 to 156 weeks). Imaging that identified the tumour took place as an outpatient in 28.3%, an inpatient in 43.3% and from the emergency department in 19.5%. 3.1% of children were referred via a “two week wait” cancer referral. The most frequent symptoms and signs at symptom onset were headache (46%), vomiting (41%), abnormal coordination (12%), abnormal gait (12%), lethargy (12%); and at diagnosis were vomiting (53%), headache (48%), abnormal coordination (26%), abnormal gait (23%), lethargy (21%), and papilloedema (21%). The medium SI prior to campaign launch was 9.3 weeks, and after launch 6.9 weeks (p = 0.043); mean SI during the same period was 22.9 and 21.0 weeks. The median consultation to diagnosis interval was 3 weeks prior to launch; post launch it was 2.3 weeks during the first 6 months, and reduced to 1.0 week between the 7th – 18th month of the campaign (p = 0.026). Changes in mean during the same period did not show a reduction trend; mean SI 15.2, 10.3, 13.3 weeks, respectively. Conclusions Analysis of the SI experienced by UK children before and after the HeadSmart launch suggests that the SI and the consultation to diagnosis interval have reduced. Further data is required to determine whether this reduction is sustained.