Though delays in the diagnosis of cancer in children are short and attributable to clinical presentation and healthcare system complexity, the impact of such delays on prognosis remains unclear, according to a new study.
Published in the August 15, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, a review of the published literature found that delays could be generally attributed to gatekeeper-type healthcare systems, clinical presentation and stage of disease, as well as parent/patient factors. The study concludes that further research should focus on understanding the impact of delays in diagnosis on morbidity and mortality in children with cancer.
Pediatric cancers, such as leukemia and brain tumors, are rare, but in some countries are the leading cause of death in children from birth to 15 years old. In the U.S., almost 10,000 children are diagnosed with cancer annually. Though incidence rates have increased slightly, five-year survival rates have also increased over the past 30 years to 80 percent in the most recent time period. As in adult cancers, early diagnosis is one of the primary factors related to survival. It is even more important in children because compared to adult malignancies, childhood cancers tend to be more invasive and grow more rapidly.
Studies characterizing and explaining the causes of delays in diagnosis are in their infancy. The few studies that have been done have been limited by methodological weaknesses, such as relying on retrospective chart reviews. As a prelude to a large audit study of diagnosis and treatment delays in Canadian children with cancer Tam Dang-Tan, an epidemiology PhD student working with Dr. Eduardo Franco from McGill University in Montreal, Canada, conducted the first ever analysis of all published studies to look for general trends and associations in this topic.
The authors reviewed 23 studies conducted worldwide and found that delays in diagnosis were generally short but the range of the data included much longer time delays. Because of the small number of studies, there were no conclusive associations between cancer type and time delays. However, brain tumors and retinoblastomas tended to have longer delays than other cancers. In addition, physician-caused delays tended to be longer than those caused by parental or patient recognition of disease.