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Diagnostic delay in pediatric malignancies--a population-based study
H Thulesius1, J Pola, A Håkansson
1Department of Community Medicine, University Hospital MAS, Malmö, Sweden. hans.thulesius@telia.com
Insights
This study analyzed pediatric malignant tumors in Sweden, finding leukemia and brain tumors most common. Early diagnosis in primary care is crucial, though delays impact outcomes, especially for brain tumors.
Area of Science:
- Pediatric Oncology
- Primary Care Medicine
- Epidemiology
Background:
- Malignant tumors in children (0-16 years) present a significant health challenge.
- Understanding the diagnostic pathway from a primary care perspective is essential for timely intervention.
Purpose of the Study:
- To investigate the incidence and diagnosis of childhood malignant tumors in a Swedish county.
- To analyze the role of primary care versus specialist care in initiating the diagnostic process.
- To evaluate diagnostic delays in pediatric cancer patients.
Main Methods:
- Retrospective analysis of patient records (primary care and hospital) for children diagnosed with malignant tumors between 1984-1995.
- Calculation of incidence rates and analysis of diagnostic pathways.
- Assessment of parent and doctor delays in the diagnostic process.
Main Results:
- An incidence of 14/100,000 children was observed, with leukemia (25 cases) and brain tumors (22 cases) being most frequent.
- Primary care initiated the diagnostic process in 68% of cases.
- Median diagnostic delays were longer for brain tumors (9 weeks total lag time) compared to leukemia (3 weeks total lag time).
Conclusions:
- Primary care plays a pivotal role in the initial diagnosis of pediatric malignant tumors.
- Reducing diagnostic delays, particularly for brain tumors, is critical to improve patient outcomes.
- Further strategies are needed to optimize the diagnostic pathway for childhood cancers.
Abstract:
This study describes the discovery and diagnosis of malignant tumors from a primary care perspective in a Swedish county. Between 1984 and 1995, 68 children between the ages 0-16 years were diagnosed with a malignant tumor giving an incidence of 14/100,000. Patient records from both primary care and hospital were analyzed for 64 children. Leukemia was diagnosed in 25 children, and brain tumors in 22 children. In 68% of the children the diagnostic process was initiated in primary care, and in 32% in specialist care. Median parent's delay (time from first symptoms to first consultation), and median doctor's delay (time from first consultation to diagnosis) were 5 and 3 weeks for children with brain tumors, and 1 and 0 weeks for children with leukemia. Median lag time (parent's + doctor's delay) was 9 weeks for patients with brain tumors and 3 weeks for children with leukemia.