1. Please go to www.menti.com & enter the code 77 15 75

2. Non-specific symptoms in children and young people: are you HeadSmart?
Dr Rebecca Chellaswamy
GP & RCGP Clinical Lead for Brain Tumours in Children

3. Overview of the session
Welcome
Introduction & setting the scene
Interactive case studies
Introduction to Brain Tumours in Children Toolkit
Key note speech
Summary & close

4. Why is this important? RCGP Special Project for 2016-2017
Over 550 children/young people (CYP) are diagnosed with a brain tumour each year in the UK
Second most common cancer in CYP but commonest cancer cause of death
Symptoms can be non-specific & variable
HeadSmart campaign launched in 2011 – increased awareness amongst paediatricians but not significantly amongst GPs
We are very happy to see so many of you here today
We appreciate that GPs have to have such a huge breadth of knowledge & fortunately brain tumours are rare but there are 550 new cases per year - approx 10 cases diagnosed per week
Second most common cancer occuring in CYP (behind leukamias) but biggest cancer cause of death in under 18s
Rare but devastating for every child and family affected
Survival rates have increased (70%) but the majority (2/3) of survivors are left with life-altering disability
Symptoms can be non-specific & can vary widely
The HeadSmart campaign was launched in 2011 to increase awareness of brain tumours in children amongst health professionals AND the public
In a HeadSmart post-launch survey, 73% of paediatricians were aware of the HeadSmart campaign but only 26% of GPs – partly why the partnership with the RCGP came about
GPs see many many children who do NOT have a serious diagnosis but we all worry about missing the few who do – in the case of suspected brain tumours, there ARE resources which can help decide whether children need to be reviewed, referred for a scan or simply reassured
Diagnosing at earliest possible stage will minimize both morbidity AND mortality

5. Two of the main reasons why brain tumours are difficult to diagnose is that the signs/sx can vary widely depending on the age of the child & the tumour location
The classical symptoms of headache & nausea/vomiting may well NOT be present depending on location
e.g. in a supratentorial tumour, only around 10% present with a headache or with nausea/vomiting – whereas these are the top two most likely presenting sx in a posterior fossa tumour

6. Survey findings
N = 142
Level of confidence in ability to recognise signs/sx of brain tumour = 4.8/10
Aware of any specific guidance = 28%
HeadSmart campaign:
Aware of it = 33%
Seen/used the resources = 15%
At the start of this project, we did a survey of 142 GPs
Their level of confidence in their ability to recognise a brain tumour was only 4.8/10
Very few of them were aware of any guidance on this issue (those who were mentioned NICE)
Very few of them were aware of HeadSmart and fewer still had seen or used the resources
Within the survey, we asked GPs whether they felt that a range of specific symptoms/signs were suggestive of a brain tumour & I’m going to show you a selection of these results…

7. Recognition of key symptoms/signs: Abnormal eye movements
Not at all suggestive = 2%
Probably not suggestive = 24% {26% thought not suggestive}
Suggestive = 50%
Extremely suggestive = 24%
NB. Blurred/double vision: 96% said suggestive or very suggestive (4% said probably not, no one said not at all suggestive)

8. Recognition of key symptoms/signs: Head tilt/torticollis
Not at all suggestive 6%
Probably not suggestive 53% {nearly 60%}
Suggestive 30%
Extremely suggestive 12%

9. Recognition of key symptoms/signs: Late puberty
Not at all suggestive 8%
Probably not suggestive 67% {75%}
Suggestive 23%
Extremely suggestive 2%

10. Recognition of key symptoms/signs: Polydipsia
Not at all suggestive 6%
Probably not suggestive 52% {nearly 60%}
Suggestive 42%
Extremely suggestive 1%

11. Resources which GPs think they would find most useful
Website including easy to access links to key resources
Online decision support tools
CPD accredited elearning module
Pocket-sized ’symptom cards’
In the survey, we also asked the 142 GPs what they thought they would find useful in terms of resources
Over 80% thought a website would be useful
80% thought online decision support tools AND an elearning module would be useful or very useful
Nearly 70% thought little symptom cards with an overview of key signs/symptoms would be useful or very useful
We have produced an online toolkit which includes links to all of these things and I will be talking a bit more about that later.

12. Short film