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Pediatric hematological malignancy: Identification of issues involved in the road to diagnosis
Jeyaanth P Venkatasai1, Srividya Srinivasamaharaj1, Latha Magatha Sneha2
1Department of Pediatrics, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
Insights
Delayed diagnosis of childhood cancers in developing countries is linked to healthcare system delays, impacting prognosis. Early pediatrician consultation significantly reduces diagnostic time for pediatric malignancies.
Area of Science:
- Pediatric Oncology
- Public Health
- Healthcare Management
Background:
- Childhood malignancy is a leading cause of pediatric mortality.
- Early diagnosis and treatment are crucial for optimal prognosis.
- Understanding diagnostic delay factors is vital for improving outcomes.
Purpose of the Study:
- To assess referral patterns in childhood malignancy diagnosis.
- To identify factors contributing to diagnostic delays in a developing country.
Main Methods:
- Retrospective study of 70 pediatric hematological malignancy patients (July 2012-August 2013).
- Interviews with parents using a questionnaire on symptoms, healthcare interactions, and referrals.
- Statistical analysis of collected data.
Main Results:
- Mean diagnostic delay of 26 days, primarily due to healthcare system factors.
- Lower socioeconomic status and non-allopathic treatment correlated with longer delays.
- Pediatrician referrals resulted in significantly shorter diagnostic times (P=0.043).
Conclusions:
- Diagnostic delays negatively impact prognosis, leading to advanced disease and aggressive treatment.
- High clinical suspicion and prompt intervention are essential for favorable outcomes.
- Addressing healthcare system delays is critical to reduce childhood cancer mortality.
Introduction:
Childhood malignancy, although a rare phenomenon, is still the leading cause of mortality in the pediatric population. Early diagnosis and treatment are imperative for the achievement of optimal prognosis. The study of factors facilitating the delay in diagnosis is thus of utmost importance, to both shorten the diagnostic delay and allow for early therapeutic intervention, facilitating a higher prognosis.
Objective:
To assess the referral pattern and the identification of potential delays in the diagnosis of childhood malignancy in a developing country.
Methodology:
The study was conducted in the Pediatric Hematology and Oncology department of Sri Ramachandra University, Chennai, India. The study included randomly selected 70 pediatric patients diagnosed with a hematological malignancy, from July 2012-August 2013. The parents were interviewed using a prepared questionnaire about patient symptomatology, interaction with healthcare providers, final diagnosis, and referral details. Data were statistically analyzed using Statistica® (STATsoft).
Results:
70 patients were included in the study (69% boys, 31% girls). The diagnostic delay was primarily due to the delay experienced in the healthcare system, with a mean delay of 26 days (Median: 18; Range: 5-39). Those from a lower socioeconomic background and whom opted for a non-allopathic treatment approach experienced higher diagnostic delays. Diagnostic time was significantly shorter for those who visited a pediatrician versus the patients who visited a general physician or super specialties (P = 0.043).
Conclusions:
Diagnostic delay is often associated with an extensive disease presentation, an aggressive therapeutic approach, and has a negative impact on patient prognosis. To lower mortality rate and facilitate a favourable prognosis, diagnosis requires a high degree of clinical suspicion and immediate intervention.