Cross-sectional study on evaluation of diagnostic interval in children with newly diagnosed paediatric cancers and factors affecting it

Abstract

BackgroundDiagnostic 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. MethodsThis 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. ResultsOut 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. ConclusionsSignificant delay exists in paediatric cancer management in LMIC. Augmentation of physician and parental awareness is the key to decrease these delays.