Factors associated with the latency to diagnosis of childhood cancer in Peru

Vásquez, Liliana; Oscanoa, Mónica; Tello, Mariela; Tapia, Elena; Maza, Iván; Gerónimo, Jenny

doi:10.1002/pbc.26134

Cited by 24 publications

(34 citation statements)

References 25 publications

(61 reference statements)

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“…There is little uniformity in the association of factors influencing diagnostic delays in LMICs in the literature, suggesting varying impact of age, sex, distance to a pediatric cancer center, type of cancer, and metastasis on time to diagnosis. For example, studies in Nigeria, South Africa, Brazil, and now our study suggest that the age of the child does not significantly affect time to diagnosis, which differs from studies in Peru, Turkey, Egypt, Indonesia, and Mexico (Supporting Information Table S1). However, these comparisons are limited by the differing categorizations of age in the literature with some studies using cutoffs, such as less than or greater than 13 as used in our study and others using age as a continuous variable or different groupings.…”

Section: Discussioncontrasting

confidence: 91%

“…Botswana has a relatively comparable pediatric cancer time to diagnosis to other studies in LMICs: Nigeria: 13.1 weeks; Peru: 8.8 weeks; Turkey: 7.6 weeks; South Africa: 4.9 weeks (Table ). Although our study delineated between time to diagnosis, defined as the time of symptom onset to the date of diagnosis, and a subset of that delay, pretreatment center delay, defined as date of symptom onset to date of presentation to PMH, we did not have information regarding the date patients first sought medical treatment at their local clinic or hospital.…”

Section: Discussionmentioning

confidence: 75%

“…Therefore, we were unable to determine the exact nature of the pretreatment center delay. Uniformly, the studies that evaluated pretreatment center delay found that health system delay, from when the patient first presented for medical care to when they arrived at a treatment center, was significantly longer than pre‐health system delay, from when the patient first noticed symptoms to when they first sought medical treatment …”

Section: Discussionmentioning

confidence: 99%

“…Time to diagnosis is a standard time‐to‐event definition within the literature that is also sometimes referred to as diagnostic delay, overall delay, latency to diagnosis, and lag time . Often time to diagnosis is further subdivided into patient delay and health system delay, delineated by the date the patient first sought any form of medical assessment.…”

Section: Methodsmentioning

confidence: 99%

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Factors influencing diagnostic delays of pediatric cancers in Botswana

Carpenter

Slone

Scheuer

et al. 2020

Pediatric Blood & Cancer

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Background A major barrier in improving cancer outcomes in Botswana and other low‐ and middle‐income countries is timely access to care. Understanding time to diagnosis of pediatric cancers in Botswana and evaluating factors contributing to delays was necessary to inform interventions. Methods A retrospective cohort study of children diagnosed with cancer at Princess Marina Hospital from 2008 to 2015 was performed utilizing the Botswana Pediatric Oncology Database. The time to diagnosis, pretreatment center delay, and pathology turnaround time were calculated. Time to diagnosis was analyzed using univariate and multivariate analyses to determine association with age, sex, distance to a treatment center, HIV status, cancer type, outcome, and presence of metastasis at diagnosis. Results The median time to diagnosis was 10.7 weeks, median pretreatment center delay was 9.6 weeks, and median pathology turnaround time was 3 weeks. Longer time to diagnosis was significantly correlated with presence of metastasis at diagnosis. Age, sex, distance to a treatment center, HIV status, cancer type, and outcome were not significantly associated with diagnostic delay. Conclusion Children with cancer in Botswana have more than three months of symptoms prior to diagnosis, which is associated with metastasis at diagnosis. Efforts should be made to empower and promote awareness of pediatric cancer symptoms among caregivers and community healthcare providers in order to shorten time to presentation at a treatment center.

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Section: Discussioncontrasting

confidence: 91%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Factors influencing diagnostic delays of pediatric cancers in Botswana

Carpenter

Slone

Scheuer

et al. 2020

Pediatric Blood & Cancer

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“…Bone tumors may have a longer LD than other types of tumors due to a slow growth rate and frequent presentation in teenagers . In Peru, a high percentage of metastatic disease at presentation (near 40%) and delayed diagnosis in children with osteosarcoma and other solid tumors have been previously reported …”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of diagnostic and treatment delays in children with osteosarcoma

Vásquez

Silva

Chávez

et al. 2020

Pediatric Blood & Cancer

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Background The aim of this study is to evaluate the relationship between the latency to diagnosis (LD) and the time to completion of chemotherapy (TCC) with clinical outcomes in children with osteosarcoma. Methods We performed a retrospective analysis of all patients who received treatment for osteosarcoma in two tertiary centers in Peru from 2008 to 2015. All causes of delayed LD or TCC were evaluated. Overall survival (OS) and event‐free‐survival (EFS) were estimated and compared according to LD, TCC, and established clinical prognostic factors. Results One hundred and thirteen patients were included in the study. The median LD was 13.5 weeks (interquartile range, 10‐18.5 weeks). No association was observed among clinical stage, tumor size, and LD. Delayed LD was not associated with a worse clinical outcome. Multivariate analysis confirmed that OS and EFS were significantly worse in cases of a delayed TCC (≥4 weeks), with hazard ratios of 2.70 (1.11‐6.76, P = 0.003) and 1.13 (1.00‐1.26, P = 0.016), respectively. Most delays in TCC (85%) were due to extramedical reasons (e.g., lack of available hospital beds). Conclusion The LD did not seem to influence the EFS and OS in pediatric patients with osteosarcoma. However, a delay in TCC from any cause is independently associated with poor outcome in pediatric patients with osteosarcoma. Based on these results, further efforts may be needed to avoid treatment delays in patients with osteosarcoma in middle‐income countries.

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