Time to diagnosis of pediatric oncologic disease: Ten-year experience from a Level II hospital

Abstract

Objectives: Despite rare, childhood cancer is a major cause of child morbidity and mortality. Reducing time to diagnosis and engaging health professionals in early treatment are key when dealing with pediatric cancer. In this study, time to diagnosis and its determinants were assessed. Methods: A descriptive and observational study in the Pediatric Department of a Level II hospital was conducted using clinical records of children diagnosed with cancer between 2007 and 2016. Using Mann-Whitney’s test, Kruskal-Wallis’ test, and Spearman’s correlation test, differences in time to diagnosis across subgroups of children according to age, gender, parental age, type of first medical visit, and diagnosis were assessed. Results: One hundred and five pediatric tumor cases were included in the analysis: 48 (46%) brain and central nervous system tumors, 32 (30%) hematological tumors, and 25 (24%) solid tumors. In the hematological subgroup, older age was associated with longer time to medical services demand (r=0.38, p=0.04) and children initially observed in primary health care exhibited longer time to diagnosis compared with children initially observed in Pediatric emergency services (median 1.9 vs 0 weeks, p=0.01). The median number of medical visits before the definitive diagnosis was one (min=0, max=7). Conclusions: Differences found in time to diagnosis between different types of medical services disclose the need for improving diagnosis in the primary care setting. A high index of suspicion is mandatory, especially among adolescents, as this is a subgroup typically associated with longer times to diagnosis.