Pediatric hematological malignancy: Identification of issues involved in the road to diagnosis

Abstract

Introduction: Childhood malignancy, although a rare phenomenon, is still the leading cause of mortality in the pediatric population. Early diagnosis and treatment are imperative for the achievement of optimal prognosis. The study of factors facilitating the delay in diagnosis is thus of utmost importance, to both shorten the diagnostic delay and allow for early therapeutic intervention, facilitating a higher prognosis. Objective: To assess the referral pattern and the identification of potential delays in the diagnosis of childhood malignancy in a developing country. Methodology: The study was conducted in the Pediatric Hematology and Oncology department of Sri Ramachandra University, Chennai, India. The study included randomly selected 70 pediatric patients diagnosed with a hematological malignancy, from July 2012-August 2013. The parents were interviewed using a prepared questionnaire about patient symptomatology, interaction with healthcare providers, final diagnosis, and referral details. Data were statistically analyzed using Statistica^® (STATsoft). Results: 70 patients were included in the study (69% boys, 31% girls). The diagnostic delay was primarily due to the delay experienced in the healthcare system, with a mean delay of 26 days (Median: 18; Range: 5-39). Those from a lower socioeconomic background and whom opted for a non-allopathic treatment approach experienced higher diagnostic delays. Diagnostic time was significantly shorter for those who visited a pediatrician versus the patients who visited a general physician or super specialties (P = 0.043). Conclusions: Diagnostic delay is often associated with an extensive disease presentation, an aggressive therapeutic approach, and has a negative impact on patient prognosis. To lower mortality rate and facilitate a favourable prognosis, diagnosis requires a high degree of clinical suspicion and immediate intervention.

Key words

Childhood cancer - developing country - diagnostic delay - road to diagnosis

Publication History

Article published online:
22 December 2020

• References

• 1 Stiller CA, Marcos-Gragera R, Ardanaz E, Pannelli F, Almar Marqués E, Cañada Martinez A, et al. Geographical patterns of childhood cancer incidence in Europe, 1988-1997. Report from the automated childhood cancer information system project. Eur J Cancer 2006;42:1952-60.
• 2 Satyanarayana L, Asthana S, Labani SP. Childhood cancer incidence in India: A review of population-based cancer registries. Indian Pediatr 2014;51:218-20.
• 3 Chirdan LB, Bode-Thomas F, Chirdan OO. Childhood cancers: Challenges and strategies for management in developing countries. Afr J Paediatr Surg 2009;6:126-30.
• 4 Stefan DC, Baadjes B, Kruger M. Incidence of childhood cancer in Namibia: The need for registries in Africa. Pan Afr Med J 2014;17:191.
• 5 Martin S, Ulrich C, Munsell M, Taylor S, Lange G, Bleyer A. Delays in cancer diagnosis in underinsured young adults and older adolescents. Oncologist 2007;12:816-24.
• 6 Abdelkhalek E, Sherief L, Kamal N, Soliman R. Factors associated with delayed cancer diagnosis in egyptian children. Clin Med Insights Pediatr 2014;8:39-44.
• 7 Araz NC, Guler E. Delays in diagnosis of childhood cancer in Southeastern Turkey and the associated factors. Pediatr Hematol Oncol 2015;32:153-63.
• 8 Ramesh PM, Marwaha RK, Anish TS. Childhood cancer in developing society: A roadmap of health care. Indian J Med Paediatr Oncol 2011;32:30-3.
• 9 Haimi M, Peretz Nahum M, Ben Arush MW. Delay in diagnosis of children with cancer: A retrospective study of 315 children. Pediatr Hematol Oncol 2004;21:37-48.