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Evaluation of diagnostic interval in children with newly diagnosed paediatric cancers: A Cross-sectional study
Monisha Manoharan1, Sanjeev Khera2, Aparajita Gupta3
1Junior Resident (Paediatrics), Army Hospital (Research & Referral), New Delhi, India.
Insights
Significant delays in diagnosing childhood cancer in low- and middle-income countries (LMICs) contribute to mortality. Physician referral delays are the primary cause, highlighting the need for increased awareness to improve pediatric cancer outcomes.
Area of Science:
- Pediatric Oncology
- Global Health
- Cancer Epidemiology
Background:
- Diagnostic delay (DI) in pediatric cancer is a critical factor in mortality, especially in low- and middle-income countries (LMICs).
- Limited data exists on DI and its contributing factors in LMICs, hindering targeted interventions.
Purpose of the Study:
- To evaluate the diagnostic interval (DI) and identify factors influencing delays in pediatric cancer diagnosis in an LMIC setting.
- To analyze patient interval (PI) and treatment interval (TI) in conjunction with DI.
Main Methods:
- A cross-sectional study involving 120 children under 12 with suspected or confirmed malignancies.
- Exclusion criteria included prior chemotherapy, death before diagnosis, and benign tumors.
- Data collected via caregiver interviews using a customized questionnaire.
Main Results:
- Of 79 analyzed children, the median DI was 17 days, with 41.8% experiencing prolonged DI (>30 days).
- Physician referral delay was the main contributor to overall delay (median total delay 74 days).
- Trial of alternative medicine was the sole significant factor associated with prolonged DI (OR=6.24).
Conclusions:
- Substantial delays in pediatric cancer diagnosis and management persist in LMICs.
- Enhancing physician and parental awareness is crucial to mitigate diagnostic delays and improve outcomes for children with cancer.
Background:
Diagnostic interval/delay (DI) denotes the duration between first presentations to healthcare provider to the definitive diagnosis of cancer. Prolonged DI is a major contributor to deaths among children with malignancies in low-middle-income countries (LMICs). The data on DI and factors affecting it are limited from LMIC.
Methods:
This cross-sectional study enrolled patients/children<12 years with proven/suspected malignancies. Children already on definitive chemotherapy, who died before a definitive diagnosis and with benign tumours were excluded. The parents or caregivers were interviewed individually using a customized questionnaire. Various intervals in referral chain like patient interval/delay (PI), DI and treatment interval/delay (TI) and factors affecting DI were evaluated.
Results:
Out of 120 eligible children; 79 with median age 43 months (interquartile range [IQR]: 28-81) were analyzed. Haematological malignancies (n = 40) and non-haematological malignancies (n = 39) were equally distributed. Median total delay was 74 days (14-88 days). Median DI was 17 days (IQR: 8-54). The main contributor to delay was due to referral delay by primary and secondary physician (p < 0.05). The median PI was 2 day (IQR: 0-7.5) and median TI was 1 day (IQR: 0-4). Prolonged DI (DI > 30 days) was seen in 33 (41.8%) children. Trial of alternative medicine was the only significant factor associated with prolonged DI in univariate and multivariate analysis with odds ratio of 6.24. Other demographic, socioeconomic, health-seeking journey and disease-related factors were not found to be associated with prolonged DI.
Conclusions:
Significant delay exists in paediatric cancer management in LMIC. Augmentation of physician and parental awareness is the key to decrease these delays.
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