Diagnostic Delay in Pediatric Cancer in Enugu, Nigeria: A Prospective Study

Abstract

Childhood cancer is a leading cause of childhood mortality in developed countries though ranks lower than infections in developing countries. Most patients with malignancies present late to hospital with consequent adverse outcome. Early diagnosis, therefore, is an important requirement in pediatric oncology as delayed diagnosis is associated with poor prognosis and huge economic cost. The study aims to identify factors associated with delay in the diagnosis of childhood cancer at University of Nigeria Teaching Hospital, Enugu.Children aged 0-17 years with admitting diagnosis of cancer which was histologically confirmed were reviewed prospectively over a 3-year period. An interviewer structured questionnaire was administered to patients or parents/caregivers to obtain information on patients' biodata, their symptoms as well as visit to health professionals or alternative health care providers before presentation at this hospital.Ninety patients were confirmed to have cancer. Overall median lag time (LT) was 15.7 weeks. Major contributors to delay were parents and the type of cancer patients presented with. Acute lymphoblastic leukemia (ALL) had the shortest median LT of 4.2 weeks while Hodgkin's disease had the longest median LT of 53.6 weeks (p = 0.01, Mann-Whitney test, 2-tailed). The median parent's delay was 12.3 weeks and health system delay was 3.6 weeks showing a significant difference in the two categories of delay (p < 0.0001, Mann-Whitney test, 2-tailed). The median treatment delay was 5 days.Public awareness and health system reform is imperative in reducing the delay in diagnosis of childhood cancer in our environment.

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.…”

“…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.…”

“…This is similar to what was reported in Nigeria. 15 This delay could especially occur among patients who are diagnosed in other hospitals and are referred to MTRH for care. It could also happen as some families take time before reaching a decision on whether to start treatment for their children.…”

“…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.…”