Factors Associated with Delayed Cancer Diagnosis in Egyptian Children

Abstract

BACKGROUNDDespite tremendous importance of early cancer diagnosis in children, few studies on this topic have been conducted in Egypt. Early stage diagnosis can have a positive effect on prognoses and the quality of life of children with cancer. We investigated delays in the diagnosis of childhood cancers in Egypt and determined the factors associated with these delays.METHODSThis retrospective study included 172 children with cancer from two pediatric oncology units. The interval between symptoms onset and final diagnosis for each child was estimated and examined by univariate and multivariate analyses to determine correlations with the child’s sex, age at diagnosis, type and site of malignancy, family residence, socioeconomic status, and parental educational level.FINDINGSThe median total diagnosis delay period was 47 days caused by patients and/or parents (8 days) and diagnosis (28 days). Statistically significant patient factors associated with delayed diagnosis were age (<5 years), lower parental education, and socioeconomic status. Sex residence and family size were not significant. Malignancy type and tumor site significantly affected the time for diagnosis. The lowest median value was associated with germ cell tumors (GCTs) and leukemia, and the highest value was in children with brain tumor. Missed diagnoses were initially recorded in 39.5% of the patients and were associated with patient and tumor factors.INTERPRETATIONDelayed diagnosis of childhood cancer is related to age, family, socioeconomic status and parental education, and cancer type and site. Efforts should be made to promote awareness, develop effective steps to eliminate possible contributing factors, and determine the best intervention method.

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

“…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.…”

“…The sex of the child has been found not to influence diagnosis delay in different studies. 16,17,23,24 This may imply that there are no differences in health-seeking behavior regardless of the gender of the child.…”

“…15,16,17 Most common diagnosis in this series was nephroblastoma, followed by non-Hodgkin lymphoma and acute lymphoblastic leukemia. The type of cancer only significantly affected treatment delay.…”

“…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.…”

“…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.…”