Delays in diagnosis and treatment among children and adolescents with cancer in Canada

Dang-Tan, Tam; Trottier, Helen; Mery, Les; Morrison, Howard; Barr, Ronald D.; Greenberg, Mark; Franco, Eduardo L.

doi:10.1002/pbc.21600

Cited by 96 publications

(153 citation statements)

References 19 publications

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“…The short total delay reported from South-Africa could be a reflection of the superior infrastructure and health-care system in the country and is similar to total delays found in high-income countries, such as Canada which also has a median total delay of 34 days. [15][16][17][18] Health-care system delay in our study was significantly longer than patient delay. This is unlike what has been reported by the Nigerian study where patient delay was longer than health-care system delay as well as the Burkitt lymphoma study in Western Kenya.…”

Section: Discussionmentioning

confidence: 68%

“…Although the total delay figures are similar to findings in Nigeria where median total delay was 109 days, our figures are longer than what has been reported in other studies done in Africa. [15][16][17][18] A study done in Western Kenya and Uganda, specifically looking at Burkitt lymphoma, reported total delays of 12.1 and 12.9 weeks respectively. This is shorter than what we found though close to what we found in our Non-Hodgkin lymphoma patients who had a mean total delay of 73 days.…”

Section: Discussionmentioning

confidence: 99%

“…However the Egyptian and South-African study also demonstrated a longer health-care system delay. [15][16][17][18][19] This may mean that parents in our setting come to hospital relatively fast but a lot of delays occur in the health-care system. These could be because medical workers are not able to suspect and make the right diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Njuguna

Martijn

Langat

et al. 2016

Pediatric Hematology and Oncology

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ABSTRACT. Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment.Study participants were parents of childhood cancer patients diagnosed between August 2013and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9-1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days;P < .001).Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Njuguna

Martijn

Langat

et al. 2016

Pediatric Hematology and Oncology

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“…[12][13][14] However, available information on the correctness of this assumption is insufficient, as studies on PSI in children with brain tumors suffer from low patient numbers, retrospective design, heterogeneity of patient, disease, and treatment characteristics, and lacking outcome data. [4][5][6][7][8][9][10][11][15][16][17][18][19][20][21][22][23][24] To study the association of the PSI with disease stage at diagnosis as well as tumor control and survival outcome, we analyzed prospectively collected data on 224 homogeneously treated patients. 3.…”

Section: -2mentioning

confidence: 99%

“…3 This can lead to prediagnostic symptomatic intervals (PSI) ('diagnostic time lags') in the range of several weeks to months. [4][5][6][7][8][9][10][11] The assumption that a longer PSI may result in a more advanced disease stage and/or have an adverse impact on tumor control, survival and/or neurological/neuropsychological/quality of survival outcome may lead to selfreproaches from parents and physicians and can result in accusations of medical malpractice. [12][13][14] However, available information on the correctness of this assumption is insufficient, as studies on PSI in children with brain tumors suffer from low patient numbers, retrospective design, heterogeneity of patient, disease, and treatment characteristics, and lacking outcome data.…”

Section: -2mentioning

confidence: 99%

A long duration of the prediagnostic symptomatic interval is not associated with an unfavourable prognosis in childhood medulloblastoma

Gerber

Hoff

Bueren

et al. 2012

European Journal of Cancer

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BACKGROUND: Due to the lacking specificity of symptoms making a correct diagnosis can be a challenge in children with medulloblastoma. This can lead to prediagnostic symptomatic intervals (PSIs) of several weeks to months. It is unknown whether the length of the PSI is associated with an inferior survival outcome in this population. METHODS: To study the association of PSI with disease stage at diagnosis, tumour control and survival in children with medulloblastoma, prospectively collected data on PSI, clinical, and biological features were analysed in 224 patients diagnosed at the age of 3-18years and treated within the prospective randomised multicentre trial HIT'91. RESULTS: Patients with lower-stage disease tended towards a longer median PSI than those with higher-stage disease (M0 stage, 2.0months; M1 stage, 2.0months; M2/M3 stage, 1month; p=0.094. M0/1 stage versus M2/3 stage; p=0.025). The patient group with the longest PSI had the best survival outcome (PSI 4.0months: 10-year overall survival rate (OS), 71%; PSI <4.0months, 10-year OS, 61%; p=0.056). Age at diagnosis was positively correlated with PSI (p=0.027). No associations were found between PSI and sex histological subtype, presence of postoperative residual tumour, or c-myc and TrkC mRNA expression. CONCLUSION: Contrary to a common belief that a longer PSI may adversely affect prognosis, a longer PSI was associated with a trend towards lower metastatic stage and better survival probabilities. Nevertheless these findings do not obviate the importance of a timely diagnosis in paediatric patients with medulloblastoma. CONCLUSION: Contrary to a common belief that a longer PSI may adversely affect prognosis, a longer PSI was associated with a trend towards lower metastatic stage and better survival probabilities. Nevertheless these findings do not obviate the importance of a timely diagnosis in pediatric patients with medulloblastoma.3

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Variation in Management of Extremity Soft-Tissue Sarcoma in Younger vs Older Adults

et al. 2021

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IMPORTANCE A large proportion of extremity soft-tissue sarcomas (ESS) occur among young adults, yet this group is underrepresented in clinical trials, resulting in limited data on this population. Younger patients present many complex challenges that affect clinical management. OBJECTIVE To investigate variations in treatment management in young adults vs older adults with ESS. DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cohort study used the National Cancer Data Base (NCDB) to identify patients 18 years and older with ESS who received definitive treatment (ie, limb-sparing surgery [LSS] or amputation) between 2004 and 2014. Data analysis was conducted in November 2019. EXPOSURES Treatment regimen received among young adults (aged 18-39 years) and older adults (Ն40 years) after diagnosis with ESS. MAIN OUTCOMES AND MEASURES To detect unique factors associated with treatment decisions in young adults with ESS, multivariable analyses used logistic regressions for patterns of treatment and their association with demographic factors and tumor characteristics. RESULTSOverall, 8953 patients were identified, and among these, 1280 (14.3%) were young adults.From the full cohort, 4796 patients (53.6%) identified as male and 6615 (73.9%) identified as non-Hispanic White. More young adults than older adults underwent amputation (age 18-39 years, 104 of 1280 [8.1%]; age 40-64 years, 217 of 3937 [5.5%]; aged Ն65 years, 199 of 3736 [5.3%]), but the association was not statistically significant (age Ն65 years, odds ratio [OR], 1.49; 95% CI, 1.00-2.23; P = .05). Young adults were more likely to receive chemotherapy than older patients (age 40-65 years, OR, 0.52; 95% CI, 0.45-0.60; P = .001; Ն65 years, OR, 0.16; 95% CI, 0.12-0.20; P = .001). Conversely, young adults were less likely to receive radiation therapy compared with older

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Delays in diagnosis and treatment among children and adolescents with cancer in Canada

Abstract: Patient and referral delays were the longest time segments influencing timely diagnosis. Differences in delays were observed across age groups, cancer types and geographical regions. There was a significant trend for decreasing delays to diagnosis and treatment.

Cited by 96 publications

References 19 publications

Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

A long duration of the prediagnostic symptomatic interval is not associated with an unfavourable prognosis in childhood medulloblastoma

Variation in Management of Extremity Soft-Tissue Sarcoma in Younger vs Older Adults

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