Overall Management > Methodology

Meeting Abstract

Delay in diagnosis of children with cancer: a retrospective study of 315 children

M. Weyl Ben Arush, M. Haimi, M. Peretz Nahum, H.F. Rennert, K. Katz

Meyer Childrens Hospital, Pediatric Hematology Oncology, Haifa, Israel [M.W.B.A., M.H., M.P.N.]. Carmel Medical Center, Epidemiology, Haifa [H.F.R.]. Diagnostic Statistical Institute, Statistic, Haifa [K.K.].

Objectives. Cancer in children can be difficult to diagnose in the primary setting leading to some delay in diagnosis. 
Our aim was to determine the demographic and systemic parameters in children with solid tumors and to ascertain which of them affected the delay in diagnosis.

Methods. Lag time was defined as the interval between onset of symptoms and final diagnosis. 
A retrospective study was performed on 315 children diagnosed with a solid tumor between 1993-2001 at the Department of Hemato-Oncology at Rambam Medical Center. 
A questionnaire was completed for each child, including epidemiological, social and medical issues concerning the family, the child, the medical system and the tumor. 
Lag time, including parent delay and physician delay, was estimated for each case.

Results. Mean lag time: 15.75 weeks, median: 7 weeks, range: 0-208 weeks. 
Lowest mean values appeared in kidney tumors, highest values for epithelial tumors, brain tumors and soft tissue sarcomas. 
Mean parent delay: 4.42 weeks, median: 1 week, range: 0-130 weeks. 
Mean physician delay: 11.17 weeks, median: 4 weeks, range: 0-206 weeks. 
One-quarter of patients were diagnosed within 3 weeks, 50% within 7 weeks, and 75% within 15 weeks.

Multi-variant analysis. Five factors were found to be strongly associated with lag time: age of child (older children presented later), ethnic origin of father (greater delay if he was Sephardic), family religion (greater delay in Jews), serial number of the child in the family (greater diagnosis delay in families with one child) and family place of residence (shorter diagnosis delay in the village). 
Among the demographic and personal parameters, the best predictors for diagnosis delay were age of child and fathers ethnic origin.

Conclusions. This work demonstrated that there are several factors influencing the diagnosis delay of childhood solid tumors. 
Recognizing these factors could minimize the diagnosis delay, hence improving the chances of the child survive.