Diagnosis delays in childhood cancer: a review

Timely access to quality healthcare has become an increasingly important public health concern over the years. Early diagnosis of cancer is a fundamental goal in oncology because it allows an opportunity for timely treatment while disease burden is still in its earliest stages. Consequently, prognosis may improve, and a cure can be attained with minimal side or late effects. This review examined delays present in diagnosis of childhood cancers and factors that influence these delays. An extensive search of the literature published before April 15, 2007 was conducted for studies that evaluated any type of delay along the cancer-care continuum. Twenty-three studies were included. Diagnosis delay varied across studies. Physician delays were generally longer than those consequent to parents' or patients' recognition of underlying disease. Causes of delays can be grouped into 3 categories: patient and/or parent, disease, and healthcare. The main factors related to diagnosis delay were the child's age at diagnosis, parent level of education, type of cancer, presentation of symptoms, tumor site, cancer stage, and first medical specialty consulted. Greater understanding of factors that influence delays and the individual impact of patient and provider delays on disease severity and prognosis would be useful to form effective policies and programs aimed at ensuring timely access to healthcare for children with cancer.