Time to diagnosis and factors associated with delayed diagnosis in children with solid cancer at a tertiary referral hospital in Ethiopia

Abstract

AIM: Only one-third of children with cancer survive in developing countries, including African countries. Timely diagnosis, early treatment initiation, and access to cancer treatment are integral components of pediatric oncology care 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 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 children < 15 years old with newly diagnosed solid cancers were included in the study. The prediagnostic and pretreatment time intervals were classified into Time to Presentation (TP), Time to Referral (TR), Time to Registration (Tr), Time to Definitive Diagnosis (TDD), Time to Diagnosis (TD), and Time to Treatment (TT) from the onset of symptoms and signs to the confirmed diagnosis at the oncology treatment center, and the initiation of treatment. The parental delay, referral delay, physician delay, health care system delay, treatment delay, total delay, and associated factors were also investigated. RESULTS: A total of 250 children with newly diagnosed 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 and 5 years old. Central nervous tumors, and renal tumors were the most common solid cancers accounting for 24%, and 17.2% respectively. The median times for TP, TR, and TD were 30, 30, and 99 days respectively. The median parental, physician, healthcare system, and total time interval were 38 (IQR 12-152), 40 (IQR 15-92), 46 (IQR 21-100), and 112 (IQR 53-277) days, respectively. The shortest total interval delay was seen in patients with germ cell tumors, neuroblastoma, and wilms tumor. About 63.6% of children with cancer had a referral delay to the oncology center of more than two weeks, and the main factors were misdiagnosis of cancer and patient management for non-oncologic diseases. The associated factors affecting the time of diagnosis (TD) were parental education status (p = 0.032), the presence of community-based health insurance (p = 0.022), types of solid cancers (p = 0.04), and sites of the tumor (p = 0.035). CONCLUSIONS: Educating the caregivers, training about the symptoms and signs of childhood cancer presentations to the healthcare professionals, and designing policies and strategies for early diagnosis, referral and treatment of childhood cancer is crucial for better outcomes.