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 inAfrica. Timely diagnosis, early treatment initiation, and access to cancer treatment are integralcomponents 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 AbabaUniversity from May 2023 to May 2024. All newly diagnosed solid cancers under the age of 15were 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 theconfirmed diagnosis at the oncology treatment center. The parental delay, referral delay,physician delay, health care system delay, treatment delay, and total delay, and the factorsassociated 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 between1-5 years old. Central nervous tumors, renal tumors, retinoblastoma, and soft tissue sarcomawere 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. Themedian physician, healthcare system, treatment, and total time delay were 40, 5, 46, and 112days 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 oncologycenter of more than two weeks, and the factors associated were misdiagnosis of cancer andpatient management for non-oncologic diseases. The longer time of diagnosis (TD) wascorrelated with parental education status (p=0.007), types of solid cancers (p=0.005), and sites ofthe 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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Delayed Diagnosis Children Solid Cancer