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Delays in childhood cancer care at a tertiary care centre in Pakistan: a single-centre study
Ruqayya Manzoor1,2, Hijab Shaheen1, Ana Farooq1
1Department of Paediatric Oncology, Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
Insights
Delays in childhood cancer diagnosis and treatment in Pakistan are common, particularly for rural and low-income children. Addressing socioeconomic and health system barriers is crucial to improve survival rates for pediatric cancer patients.
Area of Science:
- Pediatric Oncology
- Health Services Research
- Global Health
Background:
- Timely diagnosis and treatment initiation are vital for childhood cancer survival.
- Paediatric oncology services in Pakistan are centralized, leading to delays for many children, especially from rural and low-income backgrounds.
- Evidence on the magnitude and determinants of these delays is limited.
Purpose of the Study:
- To determine patient, diagnostic, treatment, and health-system delays in newly diagnosed pediatric malignancies in Pakistan.
- To identify predictors of prolonged total delay (over 30 days) from symptom onset to treatment initiation.
Main Methods:
- Analysis of data from seventy-one children with newly diagnosed malignancies.
- Assessment of median total delay, patient delay, diagnostic delay, and treatment delay.
- Identification of independent predictors of prolonged total delay using logistic regression.
Main Results:
- Median total delay was 36 days, with 57.7% of children experiencing prolonged delays.
- Prolonged delay was associated with rural residence, low household income, initial healthcare contact outside a tertiary center, lack of parental education, absence of caregiver awareness, and solid tumor diagnosis.
- Children with longer delays had significantly lower 12-month event-free survival and were more likely to present with advanced-stage disease.
Conclusions:
- Delays in childhood cancer care in Pakistan stem from socioeconomic vulnerability, geographic inequity, and fragmented health systems.
- These delays are linked to advanced-stage presentation and reduced survival.
- Decentralized diagnostics, standardized referrals, primary healthcare training, social support, and community awareness are essential to mitigate delays and improve outcomes in resource-constrained settings.
Background:
Timely diagnosis and initiation of therapy are critical determinants of survival in childhood cancer. In Pakistan, paediatric oncology services are highly centralised, and most children, particularly from rural and low-income households, experience prolonged delays with limited evidence on their cumulative magnitude and determinants. This study determined patient, diagnostic, treatment and health-system delays and identified predictors of prolonged total delay, defined as a cumulative interval exceeding 30 days from symptom onset to treatment initiation, among children with newly diagnosed malignancies.
Methods:
Seventy-one children were analysed (median age 5 years; 67.6% male; 71.8% rural). Median total delay was 36 days interquartile range (IQR 49), with 57.7% experiencing prolonged delay. Survival and disease stage were significantly associated with delay duration; children with a total delay of 0-30 days achieved a 12-month event-free survival of 83.3%, which dropped to 60.0% for those with delays >90 days. Furthermore, 50.0% of children in the critical delay group presented with advanced Stages III or IV disease. Prolonged delay was independently associated with rural residence (adjusted OR 2.42), low household income (aOR 3.09), first healthcare contact outside a tertiary centre (aOR 3.96), lack of parental education, absence of caregiver awareness (aOR 2.85) and diagnosis of a solid tumour (aOR 2.67).
Results:
Seventy-one children were analysed (median age 5 years; 67.6% male; 71.8% rural). Median total delay was 36 days (IQR 49), with 57.7% experiencing prolonged delay. Patient delay exceeded 14 days in 46.5%, while health-system delay affected 61.9%. Diagnostic delays beyond 21 days occurred in 25.4% and treatment delays were comparatively limited (18.3%). Prolonged delay was independently associated with rural residence (adjusted OR 2.42, 95% CI 1.16-5.03), low household income (< 50,000 PKR; aOR 3.09, 95% CI 1.42-6.72), first healthcare contact outside a tertiary centre (aOR 3.96, 95% CI 1.82-8.63), lack of parental education, absence of caregiver awareness of childhood cancer (aOR 2.85, 95% CI 1.29-6.31) and diagnosis of a solid tumour (aOR 2.67, 95% CI 1.29-5.53).
Conclusion:
Delays in childhood cancer care in Pakistan arise from socioeconomic vulnerability, geographic inequity and fragmented health-system pathways at this single-centre site. These delays directly correlate with advanced-stage presentation and reduced survival. Decentralised diagnostics, standardised referral systems, primary healthcare training, social support and community awareness are urgently needed to reduce delays and enhance survival in resource-constrained settings.
