FACTORS ASSOCIATED WITH DELAY IN CANCER DIAGNOSIS AND TREATMENT IN CHILDREN, A STUDY FROM NORTHERN PAKISTAN.

Abstract

Objectives: This study explores various factors responsible for delay in management of Pakistani children having malignant diseases. Study Design: Cross-sectional, observational study. Setting: Pediatric Oncology Unit of Combined Military Hospital Rawalpindi. Period: 1^st March 2017 to 31^st August 2017. Material and Methods: A total of 147 children, up to 15 years of age, being managed for malignant diseases were enrolled. Data was collected by reviewing the medical record and face-to-face interviews of the parents. Time lag from onset of symptoms to start of treatment was divided in three categories, patient delay, physician delay and treatment delay. Various factors associated with delay were analyzed. Results: Out of 147 patients, 114 were male and 33 were female. Mean age was 5.76 (±SD 3.15) years. Mean patient delay was 13.36 (+ SD 27.21) days. Mean physician delay was 66.22 (+ SD 87.66) days and mean treatment delay was 17.61 (+ SD 46.20) days. In 34% of patients total delay was > 90 days. Important factors associated with delay were age of patient, type of malignancy, financial problems, distance from healthcare facility, parents’ education status, their perception about usefulness of treatment and use of alternative therapies. Patients’ gender was not significantly associated with delayed management. Discussion & Conclusion: One third of our patients had to wait for three months or more for definitive treatment to start. Physician delay was more than patient or treatment delay. It signifies that our health care system is not well equipped to promptly handle malignant diseases in children. Better training of medical professionals and improvement in diagnostic facilities can result in reduced time lag before definite treatment.