University of Nottingham Experts Call for Greater Awareness of Bone Cancer Symptoms in Children and Young Adults
New research led by experts at the University of Nottingham has highlighted the need for greater awareness of the symptoms of bone cancers in children and young adults. The study, published today in Archives of Disease in Childhood, found that over 150 cases are diagnosed annually in the UK, with young people often facing delays in diagnosis that can impact their chances of survival.
According to the paper, long-term survival rates for bone cancers have remained unchanged for over 15 years, with fewer than seven in 10 patients surviving beyond five years. This emphasizes the urgent need for earlier diagnosis and intervention.
The study identified the most common early symptoms of Ewing sarcoma and osteosarcoma, the two most prevalent types of bone cancer in young people. Based on data from over 1,400 patients, the top symptoms included pain, swelling, fever, unexplained fractures, and limping. These insights into symptom presentation could help accelerate diagnosis and improve outcomes for patients.
Professor David Walker, Emeritus Professor of Paediatric Oncology at the University of Nottingham and senior author of the paper, stated, “This paper is part of our Child Cancer Smart project, funded by Children’s Cancer and Leukaemia Group (CCLG), which focuses on identifying childhood cancers earlier in their development so that interventions can be streamlined and improved.”
He added, “Efforts to improve outcomes for children with bone tumours have not led to improvements in cure rates or disability rates for nearly two decades. It is time to look at whether accelerating diagnosis could change this static state of affairs.”
The research also revealed differences in symptom presentation between patients with Ewing sarcoma and osteosarcoma. For example, those with Ewing sarcoma were more likely to experience fevers or impaired limb use, while those with osteosarcoma often reported unexplained fractures, pain, and weight loss. Understanding these differences could aid in earlier diagnosis and improve outcomes.
Dr. Anita Chithiramohan, a GP, highlighted the importance of this research in providing “valuable insights into the warning signs of bone tumours” in children. She added, “Childhood bone tumours can be challenging to diagnose because the symptoms are often non-specific and may overlap with those of more common conditions, such as injuries or infections.”
Despite bone cancer being one of the ten most common types of childhood cancer, many young people and their families do not consider it a risk. Research has found that around one in 10 patients wait over three months after noticing symptoms before consulting a healthcare professional, leading to further delays in diagnosis. GPs play a crucial role in the speed of diagnosis but may only encounter a case of childhood cancer once every 20 years.
Nicola, whose son Kieran Maxwell was diagnosed with Ewing sarcoma in 2010, expressed her frustration with the delays in diagnosis that her son faced. It took 14 months from the start of his leg pain to being referred for an X-ray, and he passed away in 2017 at the age of 18 after multiple relapses.
Nicola stated, “Kieran’s diagnosis should have been quicker. We thought we were lucky as it hadn’t spread at initial diagnosis, but Kieran’s tumour kept coming back. His first relapse was to his lungs, and the second relapse was to his heart.”
She added, “It is very difficult to treat relapsed bone cancers, and survival is very poor. Early diagnosis has a positive impact on survival, and the chance of recurrence drops quite significantly. I often wonder, if Kieran had been diagnosed earlier, would we have had the chance to save his leg and his life?”
Karen, another mother, shared her experience with her son Ben’s bone cancer diagnosis. Initially, she thought his leg pain was due to a cycling injury, but her GP immediately referred him for an X-ray, and he began treatment for osteosarcoma just six weeks later. Sadly, Ben passed away in 2020, five years after finishing treatment.
Karen said, “The speed of Ben’s diagnosis in 2014 was down to our GP. She took the pain seriously, and within six weeks of the GP appointment, his chemotherapy treatment had started. I worry that young people’s pain is not always taken as seriously as Ben’s was.”
She added, “People need to be very aware of the signs and symptoms of bone cancer, but that needs to be joined up with medics also being aware that, although rare, the child before them could be the one bone cancer case they see in perhaps their whole GP career, and to miss it would be devastating for everyone.”
Dr. Paul Nathan, a GP, explained, “There is a lack of education for GPs about children’s cancers and how they may present in primary care, whereas there is education regarding lots of adult conditions. In addition, childhood cancers are