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Delayed diagnosis of leukemia and association with morbid-mortality in children in Pernambuco, Brazil
Mecneide Mendes Lins1, Melania Amorim, Paulo Vilela
1Pediatric Oncology Unit, IMIP Hospital, Recife, Pernambuco, Brazil. mecneide.mendes@cehope.com.br
Insights
Delayed diagnosis of acute leukemia in children is common, influenced by factors like symptom presentation and family demographics. However, this delay did not impact survival outcomes at five years.
Area of Science:
- Pediatric Hematology
- Oncology
- Epidemiology
Background:
- Acute leukemia diagnosis in children can be challenging.
- Understanding diagnostic delays is crucial for improving pediatric cancer care.
Purpose of the Study:
- To determine the time interval from symptom onset to acute leukemia diagnosis in children.
- To identify risk factors associated with delayed diagnosis.
- To assess the impact of diagnostic delay on early mortality and event-free survival (EFS).
Main Methods:
- Retrospective review of medical records for children (1 month to 18 years) diagnosed with acute leukemia.
- Analysis of clinical, demographic, and healthcare provider factors.
- Statistical analysis to identify associations and significant predictors of diagnostic delay.
Main Results:
- A delay in diagnosis occurred in 55% of 288 pediatric patients, with a median delay of 31 days.
- Significant risk factors for delay included distance from tertiary care, initial outpatient consultation, bone/joint pain, larger family size, higher birth order, and younger paternal age/education.
- No significant association was found between delayed diagnosis and early morbid-mortality or 5-year EFS.
Conclusions:
- While diagnostic delays for childhood acute leukemia are prevalent and linked to specific patient/family factors, they do not appear to affect short-term survival or EFS.
- Educating primary care providers on recognizing atypical presentations of acute leukemia may help reduce diagnostic delays.
Abstract:
The objectives of this study were to describe the interval between symptom onset and diagnosis of acute leukemia, to assess risk factors for delayed diagnosis, and its effect on early morbid-mortality and event-free survival (EFS). Records of children aged 1 month to 18 years diagnosed with acute leukemia were reviewed for clinical, demographic, and health care provider factors, and for time to diagnosis. Of 288 patients diagnosed, 55% had a delay in diagnosis. The median time to diagnosis was 31 days. There were significant associations between the diagnostic delay and the distance from the tertiary care hospital (P=0.04), initial consultation in an outpatient clinic (P=0.04), presenting symptoms of bone/joint pain (P=0.04), family with more than 3 children (P=0.02), birth order of third or greater (P=0.009), paternal age <30 years (P=0.03), and paternal education <8 years (P=0.008). There was no association between delayed diagnosis and early morbid-mortality or EFS at 5 years. Initial consultation in an outpatient setting, presenting symptoms of bone/joint pain, and birth order of third or greater remained statistically significant in multivariate analyses, but the delay did not have an impact on early morbid-mortality or EFS. Education of primary care providers in atypical presentations of acute leukemia may decrease the diagnostic delay.
