Diagnostic delay in pediatric solid tumors: a population based study on determinants and impact on outcomes

Area of Science:

• Pediatric Oncology
• Epidemiology
• Health Services Research

Background:

• Pediatric tumors often present at advanced stages, potentially due to diagnostic delays.
• Understanding factors contributing to delayed diagnosis is crucial for improving outcomes in childhood cancers.

Purpose of the Study:

• To identify factors associated with diagnostic delay in pediatric tumors.
• To assess the impact of diagnostic delay on the stage and outcome of pediatric cancers.

Main Methods:

• Retrospective analysis of 390 pediatric tumors from the Singapore Childhood Cancer Registry (1997-2007).
• Multivariate linear regression used to correlate diagnostic delay with socio-demographic, disease, and healthcare system factors.
• Cox regression analysis assessed the association between delay and event-free survival (EFS).

Main Results:

• Median diagnostic delay was 5.3 weeks; younger age, abdominal/pelvic tumor sites, and incidental diagnoses were associated with shorter delays.
• Pediatric emergency units as first contact and first suspicion points correlated with reduced delay.
• Identified factors explained only 21% of the variance in delay times.
• No significant association found between delay and event-free survival or disease stage (24% presented at Stage 4).

Conclusions:

• Diagnostic delay in pediatric tumors is influenced by patient age, tumor site, and initial healthcare interactions.
• Despite identified associations, the analyzed factors accounted for a small proportion of the observed delay variability.
• Overall diagnostic delays were relatively short and did not significantly impact disease stage at presentation or patient outcomes.