Time to Diagnosis and Factors Associated with Delayed Diagnosis in Children with Solid Cancer at a Tertiary Referral Hospital in Ethiopia: A Prospective Study
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Date
2024-09
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Addis Ababa University
Abstract
Background: Only one-third of children with cancer can survive in developing countries in
Africa. Timely diagnosis, early treatment initiation, and access to cancer treatment are integral
components of pediatric oncology to improve the outcomes of children with cancer.
Objectives: The primary aim of this study was to assess the time to diagnosis (TD), and patterns
of delay among newly diagnosed pediatric solid cancer patients and to investigate associated
factors affecting time to diagnosis and treatment in a tertiary referral hospital in Ethiopia,
Materials and Methods:
This prospective study was conducted in the Pediatric Hematology and Oncology (PHO) unit,
Department of Pediatrics and Child Health, Tikur Anbessa Specialized Hospital, Addis Ababa
University from May 2023 to May 2024. All newly diagnosed solid cancers under the age of 15
were included in the study. The pretreatment diagnostic time intervals were classified into Time
to Presentation (TP), Time to Referral (TR), Time to Registration (Tr), Time to Definitive
Diagnosis (TDD), and Time to Diagnosis (TD) from the onset of symptoms and signs to the
confirmed diagnosis at the oncology treatment center. The parental delay, referral delay,
physician delay, health care system delay, treatment delay, and total delay, and the factors
associated were also investigated.
Results: A total of 250 children with solid cancers (excluding hematolymphoid cancers) were
prospectively studied with a male-to-female ratio of 1.3:1, and 49.2% of children were between
1-5 years old. Central nervous tumors, renal tumors, retinoblastoma, and soft tissue sarcoma
were the most common solid cancers accounting for 24%, 17.2%, 16.8%, and 15.2% respectively.
The median times for TP, TR, Tr, TDD, and TD were 30, 30, 2, 5, and 99 days respectively. The
median physician, healthcare system, treatment, and total time delay were 40, 5, 46, and 112
days respectively. The shortest total delay was seen in patients with germ cell tumors,
neuroblastoma, and Wilms tumor, and the longest total delay was in patients with retinoblastoma,
and endocrine tumors. About 63.6% of children with cancer had a referral delay to the oncology
center of more than two weeks, and the factors associated were misdiagnosis of cancer and
patient management for non-oncologic diseases. The longer time of diagnosis (TD) was
correlated with parental education status (p=0.007), types of solid cancers (p=0.005), and sites of
the tumor (p=0.003).
Conclusions: Educating the caregivers, training about the symptoms and signs of childhood
cancer presentations to the primary care physicians, and designing policies and strategies for
early diagnosis, referral and treatment of childhood cancer are crucial for better outcomes.
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Keywords
Delayed Diagnosis, Children, Solid Cancer