Impact of the COVID-19 pandemic on referral practices for pediatric central nervous system tumors: A Danish National Comparative Cohort Study

Background. Prolonged Diagnostic Interval (DI)s pose a challenge in childhood central nervous system (CNS) tumors. The coronavirus disease 2019 (COVID-19) pandemic altered contact with healthcare. The aim of this study was to describe DIs in children diagnosed with a CNS tumor in Denmark during the first year of the pandemic. Methods. We performed a retrospective questionnaire study, mapping time intervals and symptoms in the diagnostic pathway. We analyzed DIs measured in days and performed descriptive analyses of symptoms and contacts with health care professionals (HCP). Comparison to a pre-COVID cohort was applied. Intervals were presented as total diagnostic interval (TDI; time from symptom onset to diagnosis); Patient Interval (PI; time from symptom onset to first contact to an HCP); and DI (time from first contact to an HCP to diagnosis). Results. We included 25 patients (median age 8.2 years, 56% female). Median TDI: 98 days (IQR 26 210). The DI constituted the majority of TDI (median 70 days). Low-grade tumors displayed longer TDI than high-grade tumors. No significant difference in TDI was found when compared to a pre-COVID cohort (median 98 vs. 106 days). No hesitance to contact a doctor was reported by 88%, but 24% reported delays attributable to the pandemic. Patients reported more symptoms at onset, and the trajectory in the diagnostic pathways changed with fewer patients assessed by their general practitioner than pre-COVID. Conclusions. The DI was unaltered during the COVID-19 pandemic, but changes in trajectory were reported. Results stress the ongoing need for interventions to promote timely diagnosis.