Diagnosis of acute leukemia in children: the impact of remote residence on the time to make a diagnosis

Abstract

Background. Acute leukemia (AL) is the most common childhood cancer with an incidence rate of about 55–62 cases per 1 million children under 18 years of age. Acute leukemia is difficult to diagnose due to nonspecific symptoms, which are often hidden under the “masks” of other diseases. This problem is especially relevant for regions with a population of up to 100,000 people, where AL in children is diagnosed once every 2–5 years causing too low cancer alertness among pediatricians. Aim: to assess the delay in diagnosis depending on the areas of residence in the Tver region and area remoteness from the Tver Regional Clinical Children’s Hospital (RCC H). Material and Methods. The analysis included 35 patients hospitalized in the Department of Oncology and Hematology of the RCC H for the period from 2018 to 2023. The diagnoses were: ALL, C91.0 – 30 (86 %), AML , C92 – 3 (9 %), and AL of unspecified cell type (ALUCL ), C95.0 – 2 (5 %) patients. The mean age was 61 months. Thrombocytopenia and anemia at the time of diagnosis were found in 76 % and 78 %, respectively. Leukocytosis >20×109/L was observed in 58 %, leukopenia <3.5×109/L in 15 % of patients. In 97 % of cases, blasts (2 % to 95 %) were detected in peripheral blood. In the city of Tver (group 1) and the Tver region (group 2), 16 (46 %) and 19 (54 %) patients were identified, respectively. The mean age of patients in group 1 was 28.6 months and the mean age in group 2 was 72.3 months (p=0.1). Results. In group 1 and 2, ALL was diagnosed in 14 (88 %) and 16 (84 %), AML in 1 (6 %) and 2 (11 %) and ALUCL in 1 (6 %) and 1 (5 %) cases, p=0.6, 0.7 and 0.95, respectively. Delay in diagnosis in the general group (n=35) was observed <2 weeks in 21 (60 %) cases, 2–4 weeks – in 7 (20 %), ≥4–≤8 weeks – in 4 (11 %) and >8 weeks – in 3 (9 %) cases. Delayed diagnosis among patients living in the city of Tver and Tver region was observed <2 weeks in 7 (44 %) vs 13 (68 %) cases, 2–4 weeks – in 6 (38 %) vs 3 (17 %), ≥4–≤8 weeks – in 1 (6 %) vs 1 (5 %) and >8 weeks – in 2 (12 %) vs 2 (10 %) cases, respectively (p=0.37). There was no significant impact of the distance of the residence place from the level 3 children’s hospital providing specialized care (RCC H) on the time of diagnosis. With the removal of <50 km the diagnosis delay <2 weeks, 2–4 weeks, ≥4–≤8 weeks, >8 weeks was observed in 36, 36, 21 and 7 %, respectively. With the removal of ≥50–≤100 km, the diagnosis was made in the period of 2–4 weeks in 100 % of cases. With the removal of >100 km the diagnosis delay <2 weeks, 2–4 weeks, ≥4–≤8 weeks, >8 weeks was observed in 30, 30, 20 and 20 %, respectively (p=0.78). Conclusion. The distance from the third-level hospital did not affect the period of diagnosis of AL in children, which is achieved by holding daily on-line conferences with country hospitals and out-patient departments followed by the rapid hospitalization of children with suspected oncohematological disorders in the specialized department.