Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Delay in diagnosis and associated factors among children with cancer admitted at pediatric oncology ward, University of Gondar comprehensive specialized hospital, Ethiopia: a retrospective cross-sectional study

Delay in diagnosis and associated factors among children with cancer admitted at pediatric... Background Delay in the diagnosis of childhood cancer is one of the major health problem that contribute to decreased survival rates of children particularly in developing nations. Despite advances in the field of pediatric oncology, cancer remains a leading cause of death in children. Diagnosis of childhood cancer as early as possible is crucial to reduce mortality. Therefore, the aim of this study was to assess delay in diagnosis and associated factors among children with cancer admitted to pediatric oncology ward, University of Gondar comprehensive specialized hospital, Ethiopia 2022. Method Institutional-based retrospective cross-sectional study design was conducted from January1, 2019 to December 31, 2021 at University of Gondar comprehensive specialized hospital. All 200 children were included in the study and Data were extracted through structured check-list. The data were entered using EPI DATA version 4.6 and exported to STATA version 14.0 for data analysis. Results From the total of two hundred pediatric patients 44% had delayed diagnosis and the median delay diagnosis was 68 days. Rural residence (AOR = 1.96; 95%CI = 1.08–3.58), absence of health insurance (AOR = 2.21; 95%CI = 1.21– 4.04), Hodgkin lymphoma (AOR = 9.36; 95%CI = 2.1-41.72), Retinoblastoma (AOR = 4.09; 95%CI = 1.29–13.02), no referral (AOR = 6.3; 95%CI = 2.15–18.55) and absence of comorbid disease (AOR = 2.14; 95%CI = 1.17–3.94) were significant factors associated with delay in diagnosis. Conclusion and recommendation Delayed in diagnosis of childhood cancer was relatively lower than previous studies and most influenced by the child’s residency, health insurance, type of cancer and comorbid disease. Thus; *Correspondence: Yimenu Gardie yimenug6@gmail.com Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Gardie et al. BMC Cancer (2023) 23:469 Page 2 of 7 every effort should be made to promote public and parental understanding of childhood cancer, promote health insurance and referral. Keywords Delay in diagnosis, cancer, Children, Gondar, Ethiopia Background Most of the studies addressing delay were done in high- Delay in diagnosis of cancer (DDC) is defined as the income countries[8]. A study conducted in South Africa interval between the onset of symptoms and confirmed revealed considerable delay in diagnosing of childhood diagnosis of cancer [1]. It is one of the major health prob- cancer mostly physician delay [9]. Absences of health lem that contribute to decreased survival rates of chil- insurance in Kenya was associated with delay and aban- dren in under developed nations which is associated to donment of treatment [10]. Whereas, A study conducted non-specific symptoms of childhood cancer, nature of in Egypt, indicated that patient aged (< 5 years), lower tumor and other health care system factors [2]. parental education, socioeconomic status, malignancy It is the leading cause of disease-related death in chil- type and tumor site were affected significantly the time dren in developing countries like Ethiopia and remains for diagnosis of childhood cancer [11]. an important public health concern because of its great In Ethiopia, few studies have been conducted on delay physical and psychological impact on the affected chil - in diagnosis of childhood cancer. A study conducted on dren and their families [3]. Many possible risk factors for Clinical Presentation of Retinoblastoma at Jimma Uni- development of cancer in children and adolescents have versity Medical Center Pediatric Oncology Unit, showed been investigated [3]. However, the causes of childhood that most of 24 (75%) of the patients presented with cancer are mostly unknown. Currently, early diagnosis advanced stage (proptosis and fungating orbital mass) of followed by effective treatment is an essential approach the disease [12]. This indicates that the management of for control of the public health burden due to child- cancer in children becomes worse with poor prognosis hood cancer. Appropriate early diagnosis and treatment due to long diagnosis delay time [13]. require primary care physicians and parents to be aware The most effective strategy to reduce the burden of of early symptoms of childhood malignancies. Public cancer in children and improve outcomes is to focus on a and professional education can be effective in eliminat - prompt, timely diagnosis followed by effective, evidence- ing disparities in cancer survival [4]. In spite of these rec- based therapy with simple supportive care [9]. Even ommendations, pediatric cancer diagnosis delays have though national attempts have been tried on early diag- not received as much attention as cancers in adults in nosis of childhood cancer to improve the quality of life Ethiopia. and survival rate, there is still a big problem of delay in Late diagnosis and treatment of children with can- diagnosis due to different factors and the mortality rate is cer had a serious and life treating effect in the future of greater than 80% in Ethiopia [14]. their life. The survival chance of child with cancer in Low Few studies have been published on prevalence and and Middle income countries (LMICs), is still a major associated factors of diagnosis delays in childhood can- problem and is less than 30%, whereas 80% in developed cer in Ethiopia. To our knowledge, no study was done on countries in which the variation might be related to delay this topic in the study area. Therefore, this study aimed to in diagnosis [5]. According to the Ethiopian ministry of assess prevalence and associated factors of delay in diag- health national childhood and adolescent cancer control nosis of childhood cancer at university of Gondar spe- plan (2019–2023), it is estimated that around 6,000 child- cialized hospital pediatric oncology ward. hood cancer cases are registered every year, and 80% die from their conditions which shows extremely low cure Methods rate for childhood cancer is mainly attributed to the Study design and period country’s inability to provide cancer treatment [6]. The Institutional- based retrospective cross-sectional study plan also stated that most childhood cancers are hard was conducted from January1, 2019 to December 31, to recognize, patients arrive at health centers with an 2021. advanced level of the disease, and this has also contrib- uted to the high mortality rate [6]. Study area Causes of delays may be patient and/or parent, nature The study area was university of Gondar comprehensive of tumor, and healthcare associated factors. Studies indi- specialized hospital located at Central North Gondar cated that factors that may be related to diagnosis delay Zone, Amhara Regional state, Ethiopia. The hospital is are the child’s age at diagnosis, parent level of education, found 750 km far from Addis Ababa, capital city of Ethi- type of cancer, presentation of symptoms, tumor site, and opia and 171  km away from Bahir Dar city of Amhara first medical specialty consulted [ 7]. regional state. It is the largest hospital in Central-North Gardie et al. BMC Cancer (2023) 23:469 Page 3 of 7 Patient delayed diagnosis The time between the onset Gondar zone serving for more than 5 million people per of symptoms & signs detected by the patients to first year [15]. It is a multidisciplinary comprehensive special- health care visit (if median time ≥ 50days) [16]. ized hospital with 550 beds. University of Gondar com- prehensive specialized hospital is the only hospital that Physician delayed diagnosis the time interval from the gives functional pediatric oncology service in the region first health care provider contact to confirmed cancer which has 01 oncologist pediatrician, 11 BSC compre- diagnosis (if median time ≥ 32days) [16]. hensive nurses, and temporary resident and intern doc- tors in the ward. The unit has 35 beds but no separate radiology, pathology and physiotherapy units. Data collection tool and procedure The data were collected by using structured checklist Study population which was adapted from different literatures [ 11, 16, 17]. All registered children diagnosed with cancer at univer- The tool was prepared in English version and the data sity of Gondar comprehensive specialized hospital admit- were extracted through reviewing patient’ medical chart ted to pediatric oncology ward from January 1, 2019 to by trained data collectors. Two BSc clinical nurses and December 31, 2021. one BSc nurse (ward head) supervisor were participated for data collection. Inclusion criteria All medical records of children diagnosed with cancer Data Quality Control aged ≤ 18 years in pediatrics cancer unit at university of To assure the data quality, chart review was done on 5%( Gondar comprehensive specialized hospital from Janu- 10) of the study population to test the checklists’ struc- ary1, 2019 to December 31, 2021. ture, completeness and essential modifications were made accordingly at University of Gondar comprehen- Sample size techniques and sampling procedure sive specialized hospital. Cronbach alpha (0.75) was Since the total number of the population under investi- measured to check reliability of the tool. Face tool valida- gation was small (200), Census method was applied (all tion checked by experts; training for data collectors and registered children diagnosed with cancer at university of supervisor was given prior to data collection for half day. Gondar comprehensive specialized hospital admitted to pediatric oncology ward included as study population). Data processing and analysis According to pediatric cancer patients’ report from the The data were checked by the principal investigator on a registration book, on average 5.6 children have been vis- daily basis during data collection for completeness, and ited pediatric oncology ward per month and sixty seven consistencies. Collected Data were then coded, entered per year. Therefore, the study population size was all 200 to EPI data V4.6, cleaned and analyzed using STATA medical charts of children diagnosed with cancer who version 14.00 Software. Descriptive analysis was used to were registered from January 1, 2019 to December 31, describe the frequencies and percentages of the variables 2021. in the study. The strength of association was measured using adjusted odds ratio and 95% confidence interval. Variables of the study Binary logistic regression analysis was used to test associ- Dependent variable: Delay in Diagnosis. ations between independent variables and the dependent variable. Variables with P-value < 0.25 in bi-variable anal- Independent variables ysis were included to the multivariable logistic regres- Socio-demographic characteristics of child (sex, age, sion model. Finally, variables with P-value < 0.05 were residence, health insurance). considered as potential determinants of delayed diagno- Clinical characteristics (sign/symptom, type of malig- sis among pediatric cancer patients. The Hosmer-Lem - nancy, comorbid illness). eshow logistic regression model was fitted at (x = 10.36; Health care associated characteristics (first visited p = 0.241). facility, hospital level, referral, source for referral, medical specialty of care provider). Results Socio-demographic characteristics of study participants Operational definition A total of 200 participants were included in the study Delay in diagnosis The time interval between cancer with newly diagnosed malignancy making response rate manifestations detected to confirmed diagnosis (if median of 100%. About 131 (65.5%) of the study participants diagnosis time ≥ 90 days it is delayed) [16]. were males. The median and interquartile range (IQR) of participants’ age was 7 ± 6 years in which most of them were found in the age category of 5–10 years. Majority Gardie et al. BMC Cancer (2023) 23:469 Page 4 of 7 Table 1 Socio-demographic characteristics of study participants with cancer in UOGCSH, Gondar, North West, Ethiopia, 2022(N = 200) Variables Frequency (N) Per- cent (%) Sex Male 131 65.5% Female 69 34.5% Residence Rural 76 38% Fig. 1 Health care providers’ specialty and first contact evaluation at can - Urban 124 62% cer treatment center at University of Gondar Comprehensive Specialized Health insurance Hospital, North West, Ethiopia, 2022 (N = 200) Yes 88 44% No 112 56% Age < 5 years 64 32% 5–10 years 87 43.5% 10-≤18 years 49 24.5% Table 2 Health care system literacy of caregivers among children with cancer in UOGCSH, Gondar, North West, Ethiopia, 2022(N = 200) Variables Delayed diagnosis Yes No First visited facility Fig. 2 Delay in diagnosis of cancer among children based on type of can- Health center 11 (5.5%) 10 (5%) cer in University of Gondar comprehensive specialized hospital, Gondar, Hospital 70 (35%) 92 (46%) North West Ethiopia, 2022 (N = 200) Private clinic 7 (3.5%) 10 (5%) Referral 42 (21%) 158 (79%) Health care providers’ specialty and first contact evaluation Source of referral at cancer treatment center Health center 3 (7.14%) 10 Most patients 171(85%) were initially evaluated by intern (23.81%) doctors, 17(8.5%) evaluated by resident physicians. Hospital 1 (2.38%) 17 Weight loss 63(31.5%), pain 46(23%), abdominal mass (40.48%) 42(21%) and eye related sign/symptoms 12(6%) were pre- Private clinic 4 (9.52%) 7 (16.67%) senting common signs/symptoms among children with Hospital level cancer. Around 85(42.50%) of children with cancer had Primary hospital 17 (10.49%) 30 (18.52%) comorbid disease while the rest had not (Fig. 1). General hospital 15 (9.26%) 13 (8.02%) Specialized hospital 37 (22.84%) 50 Delay in diagnosis of cancer among children age ≤ 18 years (30.86%) admitted at oncology ward From the total of 200 patients, 88 (44%) [CI; 37-51%] had 124(62%) of the participants were urban residents. delayed diagnosis in which the majority of the delayed in 88(44%) of respondents had health insurance (Table 1). diagnosis (50%) was contributed by patients’ delay. Clinical/Health care-related characteristics of participants Delay in diagnosis of cancer among children depened on Majority of pediatric patients’ first contact with health the type of cancer care providers 162(81%) cases had seen in hospital, The most common malignancy were ALL 50 (25%) fol - 42(21.0%) of children had referral paper and most of lowed by Wilms tumor 37(18.5%) and NHL 28(14%). them were from specialized hospital 87(53.7%) (Table 2). Patients who had Wilms tumor were more delayed to be diagnosed (Fig. 2). Gardie et al. BMC Cancer (2023) 23:469 Page 5 of 7 Factors associated with delay in diagnosis of cancer among Acute Lymphoblastic leukemia and those who had Reti- children noblastoma were 4.1 (AOR = 4.09; 95%CI = 1.29–13.02) In the bi-variable analysis, sex, referral, residence, health times more likely delayed diagnosis than who had Acute insurance, comorbid disease, HL, NHL, Wilms tumor and Lymphoblastic leukemia (Table 3). Retinoblastoma were factors that had a p-value < 0.25. Variables that had a p-value of < 0.25 in the bi-variable Discussion analysis were further analyzed using multivariable logis- The aim of this study was to identify delay in diagnosis tic regression. The results of this analysis showed that and associated factors of pediatric cancer patients at uni- the area of residence, health insurance, referral, Hodgkin versity of Gondar Comprehensive Specialized Hospital. lymphoma, Retinoblastoma and comorbid disease were The overall current finding revealed that 44% of partici - found to be significantly associated with delayed diagno - pants had total delay in diagnosis. This finding is lower sis of cancer in children. than study conducted in Argentina(63.5%) and Bra- The odds of those children living in rural residence zil(55%) [18, 19]. This discrepancy might be due to dif - were 1.96 (AOR = 1.96; 95%CI = 1.08–3.58) times more ferences in sample size and included cancer type in the likely to get diagnose delayed relative to urban resi- study. dents. Similarly, the odds of children who have no health The current finding is also lower than the study con - insurance were 2 times (AOR = 2.21; 95%CI 1.21–4.04) ducted in Mekele (69.6%) and Bangladesh (70%) [16, 20]. more likely to be diagnosed delay as with compared to The difference might be due to shorter diagnosis time by those who have health insurance. Moreover, the odds physician in current study that enhances timely decision of children who had not comorbid disease were 2 times on pediatric cancer diagnosis, study period, cut off point (AOR = 2.1; 95%CI = 1.01–4.32) more likely to get delayed. in diagnosis delay and difference in socio-demographic Children having no referral had odds of 6.3 (AOR = 6.3; characteristics of the study participants. 95%CI = 2.15–18.55) times more likely delay in diagnosis Residence, referral, health insurance, comorbid disease, than children who had referral. Those who had Hodgkin Retinoblastoma and Hodgkin lymphoma cancers were lymphoma had odds of 9.4 (AOR = 9.36; 95%CI = 2.1- significant factors that contribute for diagnosis delay. 41.72) times more likely delay in diagnosis than who had Children with Retinoblastoma had odds of 4.1 times more likely delay to be diagnosed than children hav- Table 3 Factors associated with delay in diagnosis of cancer ing acute lymphoblastic leukemia keeping other vari- among children aged ≤ 18 years (UOGCSH), 2022(N = 200) ables constant. This finding is similar with that of the Variables Category Delay in Diagnosis COR AOR study done in Jimma comprehensive specialized hospi- (95%CI) (95%CI) Yes No tal and Nigeria [12, 21]. This similarity might be due to Sex Female 25(36.23%) 44(63.77%) 0.61(0.34– 1.14(0.13– a high risk of the cancer being missed on examination, 1.12)* 9.97) either because tumors are located in the anterior retina, Male 63(48.09%) 68(51.91%) 1 1 because the examination has not been done correctly, or Residence Rural 42(55.26%) 34(44.74%) 2.09(1.17– 1.96(1.08– because the child is unable to co-operate with the exam 3.74)* 3.58)** [22]. Urban 46(37.1%) 78(62.9%) 1 1 Likewise, in the current finding children having Hodg - Health Yes 30(34.09%) 58(65.91%) 1 1 kin lymphoma had odds of 9.4 times more likely delay to insurance No 58(51.79%) 54(48.21%) 2.1(1.17– 2.21(1.21– be diagnosed than children having acute lymphoblastic 3.69)* 4.04)** leukemia keeping other variables constant. This might Comorbid Yes 30(35.29%) 55(64.71%) 1 1 disease be the fact that some tests use specialized equipment No 58(50.43%) 57(49.57%) 1.9(1.05– 2.1(1.01– 3.32)* 4.32)** or need specially trained experts to find out the exact Cancer HL 12(80%) 3(20%) 9(2.23– 9.4(2.1- genetic make-up of lymphoma cells. The samples might type 36.33)* 41.72)** need to be sent to a different laboratory and can take sev - NHL 13(46.43%) 15(53.57%) 1.84(0.71– 1.54(0.54– eral times [23]. 4.77)* 4.38) From our Findings the risk of increased delay for chil- Wilms 19(51.35%) 18(48.65%) 2.24(0.93– 1.53(0.63– dren who were living in rural area was 1.96 times more 5.39)* 4.27) likely delay than urban residence keeping other vari- Retino- 14(68.18%) 8(31.82%) 3.94(1.38– 4.1(1.29– ables constant. the current finding is comparable with blastoma 11.25)* 13.03)** the study from Mekele Ayder Hospital [16]. This is due ALL 16(32%) 34(68%) 1 1 to rural areas might be far from cancer treatment center, Referral Yes 9(21.43%) 33(78.57%) 1 1 transport inaccessibility and parents’ low health seeking No 79(50%) 79(50%) 3.7(1.65– 6.3(2.15– 8.16)* 18.55)** behavior. N.B; *=p-value < 0.25 and **=p-value < 0.05 Gardie et al. BMC Cancer (2023) 23:469 Page 6 of 7 data, visualization, conceptualizationMulugeta Ayalew- Data curation, Children who have no health insurance had odds 2 methodology, supervision, investigation, validation, reviewing and editing dataYihenew Sewale- methodology, software, reviewing and editing data, times more likely to be diagnosed delay as with compared visualization, conceptualizationZelalem Feleke- methodology, software, to those who have health insurance. This is similar with reviewing and editing data, visualization, conceptualizationMelkamu Tilahun- a study done in Kenya and Mekele [10, 16]. Where have conceptualization, data curation, methodology, supervision, investigation, validation, reviewing and editing data. no insurance increased the risk of delayed in diagno- sis. Regarding the referral system, Children who had no Funding referral had odds of 6.3 times more likely delay in diag- This study was funded by Assosa University. However, the funder had no role in the data collection, analysis and preparation of the manuscript, and nosis of childhood cancer than children who had referral. publication decision. This finding is in line with the study conducted in Ibadan, Nigeria [21]. Data Availability Data generated/ analyzed during this study are found from the corresponding Moreover, Children who have no comorbid disease author. were 2 times more likely to be diagnosed delay as with compared to those who have comorbid disease keeping Declarations other variables constant. This might be due to patients having comorbid disease seeking more health care and Ethical statement We extracted anonymized medical records data for children with cancer may shorten delay in diagnosis of childhood cancer. ending between January 1, 2019 to December 31, 2021. University of Gondar is the main custodian of the registered health system and maintains the Limitation of the study system following ethical, legal privacy and confidentiality requirements. We obtained ethics approval from University of Gondar research review board, The study couldn’t incorporate parental socio-demo - college of medicine and health sciences, school of nursing (CMHSN Ethics graphic characteristics and opinions because of the Ref: 227/2022) (Date: 4 May 2022). Participant consent was not required as the nature of study design and secondary data usage. It may study used de-identified registry based secondary data. As long as the work does not violate the rights of individuals and does not include identifiable not be representative of the whole country cases as it is a information, University of Gondar permit researchers to access medical charts single institutional study. It is also difficult to determine without obtaining prior consent from participants to pursue research for strong cause and effect relationships between dependent the common good. Informed consent was waived by UOG’s research review board. This decision was in accordance with the National Research Ethics and independent variables since it is a cross-sectional Review Guideline, Sixth Edition, Chap. 7, Sect. 7.2, and was consistent with the study. Declaration of Helsinki. Consent to publish Conclusion and recommendation Not applicable. Although delays in diagnosis of cancer among children were relatively low as compared to other studies, the Conflict of interest All authors declared that they have no competing of interest in this study. prevalence of delay in diagnosis of cancer among chil- dren remains prevalent in the study area. Rural residence, Author details absence of health insurance, Hodgkin lymphoma, Reti- Department of Nursing, College of health sciences, Assosa University, Assosa, Ethiopia noblastoma, no referral and absence of comorbid were Department of medical nursing, School of Nursing, College of Health significant factors associated with delay in diagnosis of Sciences, University of Gondar, Gondar, Ethiopia childhood cancer. Therefore, it is recommended to con - Department of Midwifery, College of health sciences, Assosa University, Assosa, Ethiopia duct either large-scale community-based or qualitative Department of public health, College of health sciences, Woldia study to address those factors that hinder early diagno- University, Woldia, Ethiopia sis of cancer in children. It is also better to expand refer- Department of Pediatrics, School of Medicine, University of Gondar, Gondar, Ethiopia ral linkage, promote health insurance to patients and Department of nursing, College of health sciences, Debre Berhan children shall be evaluated more by senior health care University, Debre Berhan, Ethiopia providers. Department of pediatrics and child health nursing, School of Nursing, College of Health Sciences, University of Gondar, Gondar, Ethiopia Acknowledgements The authors thank the data collectors, data collectors’ supervisors and Received: 18 November 2022 / Accepted: 21 April 2023 administrative staff of University of Gondar comprehensive specialized hospital for their cooperation to conduct this research. We also extend our deepest gratitude to Assosa University and clinical staff of University of Gondar comprehensive specialized Hospital for their unreserved support. Without them this work would not be realized. Author Contribution References Yimenu Gardie- conceptualization, data curation, software, visualization, 1. Chukwu B, Ezenwosu O, Ikefuna A, Emodi I. Diagnostic delay in pediatric investigation, methodology, writing original dataMulugeta Wassie- cancer in Enugu, Nigeria: a prospective study. Pediatr Hematol Oncol. conceptualization, data curation, methodology, supervision, investigation, 2015;32(2):164–71. validation, reviewing and editing dataSeid Wodajo- conceptualization, 2. Cotache-Condor C, Grimm A, Williamson J, Kantety V, Landrum K, Schroeder software, methodology, investigation, validation, reviewing and editing K et al. Factors contributing to delayed childhood cancer care in low‐and dataMastewal Giza- methodology, software, reviewing and editing Gardie et al. BMC Cancer (2023) 23:469 Page 7 of 7 middle‐income countries: A systematic review protocol. Pediatr Blood 14. Hadley LG, Rouma BS, Saad-Eldin Y, editors. Challenge of pediatric oncology Cancer. 2022:e29646. in Africa. Seminars in pediatric surgery. Elsevier; 2012. 3. Little J. Epidemiology of childhood cancer. IARC scientific publications; 1999. 15. Ethiopia sCSA. statistics of Centeral North Gondar population. 2007. 4. De Camargo B, De Andrea MLM, Franco EL. Catching up with history: 16. Berhane A, Hailu T, Mulugeta A. Determinants of delayed diagnosis among treatment of Wilms’ tumor in a developing country. Med Pediatr Oncol. pediatric cancer patients from Ayder Comprehensive Specialized Hospital, 1987;15(5):270–6. Mekelle, Northern Ethiopia. BMC Pediatr. 2019;19(1):1–8. 5. Cordoba MA, Godoy N, Castaño A, Ribeiro KB, Moreno F, de Vries E. Childhood 17. Haimi M, Nahum MP, Arush MWB. Delay in diagnosis of children with cancer in Latin America: from detection to palliative care and survivorship. cancer: a retrospective study of 315 children. Pediatr Hematol Oncol. Cancer Epidemiol. 2021;71:101837. 2004;21(1):37–48. 6. Ministry of Health. ’s National Childhood and Adolescent Cancer Control Plan. 18. Moreno F, Loria D, Abriata G, Terracini B. Childhood cancer: incidence and childhood cancer. 2019. early deaths in Argentina, 2000–2008. Eur J Cancer. 2013;49(2):465–73. 7. Araz NC, Guler E. Delays in diagnosis of childhood cancer in southeastern 19. Lins MM, Amorim M, Vilela P, Viana M, Ribeiro RC, Pedrosa A, et al. Delayed Turkey and the associated factors. Pediatr Hematol Oncol. 2015;32(2):153–63. diagnosis of leukemia and association with morbid-mortality in children in 8. Brand NR, Qu LG, Chao A, Ilbawi AM. Delays and barriers to cancer care Pernambuco, Brazil. J Pediatr Hematol Oncol. 2012;34(7):e271–e6. in low-and middle‐income countries: a systematic review. Oncologist. 20. Begum M, Islam MJ, Akhtar MW, Karim S. Evaluation of delays in diagnosis 2019;24(12):e1371–e80. and treatment of childhood malignancies in Bangladesh. South Asian Journal 9. Stefan DC, Siemonsma F. Delay and causes of delay in the diagnosis of child- of Cancer. 2016;5(04):192–3. hood cancer in Africa. Pediatr Blood Cancer. 2011;56(1):80–5. 21. James B, Ajayi S, Ogun O, Oladokun R. Factors influencing time to diagnosis 10. Njuguna F, Martijn H, Langat S, Musimbi J, Muliro H, Skiles J, et al. Factors of childhood cancer in Ibadan, Nigeria Afr health Sci. 2009;9(4). influencing time to diagnosis and treatment among pediatric oncology 22. Dimaras H, Corson TW, Cobrinik D, White A, Zhao J, Munier FL, et al. Retino- patients in Kenya. Pediatr Hematol Oncol. 2016;33(3):186–99. blastoma Nat reviews Disease primers. 2015;1(1):1–23. 11. Abdelkhalek E, Sherief L, Kamal N, Soliman R. Factors associated with 23. Lester SC. Manual of Surgical Pathology: Expert Consult-Online and print. delayed cancer diagnosis in egyptian children. Clin Med Insights: Pediatr. Elsevier Health Sciences; 2010. 2014;8:CMPed. 12. Hordofa DF, Daba KT, Mengesha AA. Clinical Presentation of Retinoblastoma Publisher’s Note in Ethiopia: A Case of Jimma University Medical Center Pediatric Oncology Springer Nature remains neutral with regard to jurisdictional claims in Unit, Southwest Ethiopia. Ethiop J Health Sci. 2021;31(5). published maps and institutional affiliations. 13. Martin S, Ulrich C, Munsell M, Taylor S, Lange G, Bleyer A. Delays in cancer diagnosis in underinsured young adults and older adolescents. Oncologist. 2007;12(7):816–24. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png BMC Cancer Springer Journals

Delay in diagnosis and associated factors among children with cancer admitted at pediatric oncology ward, University of Gondar comprehensive specialized hospital, Ethiopia: a retrospective cross-sectional study

Download PDF
7 pages

Loading next page...
 
/lp/springer-journals/delay-in-diagnosis-and-associated-factors-among-children-with-cancer-JOwkuKN8KY

References (31)

Publisher
Springer Journals
Copyright
Copyright © The Author(s) 2023
eISSN
1471-2407
DOI
10.1186/s12885-023-10873-8
Publisher site
See Article on Publisher Site

Abstract

Background Delay in the diagnosis of childhood cancer is one of the major health problem that contribute to decreased survival rates of children particularly in developing nations. Despite advances in the field of pediatric oncology, cancer remains a leading cause of death in children. Diagnosis of childhood cancer as early as possible is crucial to reduce mortality. Therefore, the aim of this study was to assess delay in diagnosis and associated factors among children with cancer admitted to pediatric oncology ward, University of Gondar comprehensive specialized hospital, Ethiopia 2022. Method Institutional-based retrospective cross-sectional study design was conducted from January1, 2019 to December 31, 2021 at University of Gondar comprehensive specialized hospital. All 200 children were included in the study and Data were extracted through structured check-list. The data were entered using EPI DATA version 4.6 and exported to STATA version 14.0 for data analysis. Results From the total of two hundred pediatric patients 44% had delayed diagnosis and the median delay diagnosis was 68 days. Rural residence (AOR = 1.96; 95%CI = 1.08–3.58), absence of health insurance (AOR = 2.21; 95%CI = 1.21– 4.04), Hodgkin lymphoma (AOR = 9.36; 95%CI = 2.1-41.72), Retinoblastoma (AOR = 4.09; 95%CI = 1.29–13.02), no referral (AOR = 6.3; 95%CI = 2.15–18.55) and absence of comorbid disease (AOR = 2.14; 95%CI = 1.17–3.94) were significant factors associated with delay in diagnosis. Conclusion and recommendation Delayed in diagnosis of childhood cancer was relatively lower than previous studies and most influenced by the child’s residency, health insurance, type of cancer and comorbid disease. Thus; *Correspondence: Yimenu Gardie yimenug6@gmail.com Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Gardie et al. BMC Cancer (2023) 23:469 Page 2 of 7 every effort should be made to promote public and parental understanding of childhood cancer, promote health insurance and referral. Keywords Delay in diagnosis, cancer, Children, Gondar, Ethiopia Background Most of the studies addressing delay were done in high- Delay in diagnosis of cancer (DDC) is defined as the income countries[8]. A study conducted in South Africa interval between the onset of symptoms and confirmed revealed considerable delay in diagnosing of childhood diagnosis of cancer [1]. It is one of the major health prob- cancer mostly physician delay [9]. Absences of health lem that contribute to decreased survival rates of chil- insurance in Kenya was associated with delay and aban- dren in under developed nations which is associated to donment of treatment [10]. Whereas, A study conducted non-specific symptoms of childhood cancer, nature of in Egypt, indicated that patient aged (< 5 years), lower tumor and other health care system factors [2]. parental education, socioeconomic status, malignancy It is the leading cause of disease-related death in chil- type and tumor site were affected significantly the time dren in developing countries like Ethiopia and remains for diagnosis of childhood cancer [11]. an important public health concern because of its great In Ethiopia, few studies have been conducted on delay physical and psychological impact on the affected chil - in diagnosis of childhood cancer. A study conducted on dren and their families [3]. Many possible risk factors for Clinical Presentation of Retinoblastoma at Jimma Uni- development of cancer in children and adolescents have versity Medical Center Pediatric Oncology Unit, showed been investigated [3]. However, the causes of childhood that most of 24 (75%) of the patients presented with cancer are mostly unknown. Currently, early diagnosis advanced stage (proptosis and fungating orbital mass) of followed by effective treatment is an essential approach the disease [12]. This indicates that the management of for control of the public health burden due to child- cancer in children becomes worse with poor prognosis hood cancer. Appropriate early diagnosis and treatment due to long diagnosis delay time [13]. require primary care physicians and parents to be aware The most effective strategy to reduce the burden of of early symptoms of childhood malignancies. Public cancer in children and improve outcomes is to focus on a and professional education can be effective in eliminat - prompt, timely diagnosis followed by effective, evidence- ing disparities in cancer survival [4]. In spite of these rec- based therapy with simple supportive care [9]. Even ommendations, pediatric cancer diagnosis delays have though national attempts have been tried on early diag- not received as much attention as cancers in adults in nosis of childhood cancer to improve the quality of life Ethiopia. and survival rate, there is still a big problem of delay in Late diagnosis and treatment of children with can- diagnosis due to different factors and the mortality rate is cer had a serious and life treating effect in the future of greater than 80% in Ethiopia [14]. their life. The survival chance of child with cancer in Low Few studies have been published on prevalence and and Middle income countries (LMICs), is still a major associated factors of diagnosis delays in childhood can- problem and is less than 30%, whereas 80% in developed cer in Ethiopia. To our knowledge, no study was done on countries in which the variation might be related to delay this topic in the study area. Therefore, this study aimed to in diagnosis [5]. According to the Ethiopian ministry of assess prevalence and associated factors of delay in diag- health national childhood and adolescent cancer control nosis of childhood cancer at university of Gondar spe- plan (2019–2023), it is estimated that around 6,000 child- cialized hospital pediatric oncology ward. hood cancer cases are registered every year, and 80% die from their conditions which shows extremely low cure Methods rate for childhood cancer is mainly attributed to the Study design and period country’s inability to provide cancer treatment [6]. The Institutional- based retrospective cross-sectional study plan also stated that most childhood cancers are hard was conducted from January1, 2019 to December 31, to recognize, patients arrive at health centers with an 2021. advanced level of the disease, and this has also contrib- uted to the high mortality rate [6]. Study area Causes of delays may be patient and/or parent, nature The study area was university of Gondar comprehensive of tumor, and healthcare associated factors. Studies indi- specialized hospital located at Central North Gondar cated that factors that may be related to diagnosis delay Zone, Amhara Regional state, Ethiopia. The hospital is are the child’s age at diagnosis, parent level of education, found 750 km far from Addis Ababa, capital city of Ethi- type of cancer, presentation of symptoms, tumor site, and opia and 171  km away from Bahir Dar city of Amhara first medical specialty consulted [ 7]. regional state. It is the largest hospital in Central-North Gardie et al. BMC Cancer (2023) 23:469 Page 3 of 7 Patient delayed diagnosis The time between the onset Gondar zone serving for more than 5 million people per of symptoms & signs detected by the patients to first year [15]. It is a multidisciplinary comprehensive special- health care visit (if median time ≥ 50days) [16]. ized hospital with 550 beds. University of Gondar com- prehensive specialized hospital is the only hospital that Physician delayed diagnosis the time interval from the gives functional pediatric oncology service in the region first health care provider contact to confirmed cancer which has 01 oncologist pediatrician, 11 BSC compre- diagnosis (if median time ≥ 32days) [16]. hensive nurses, and temporary resident and intern doc- tors in the ward. The unit has 35 beds but no separate radiology, pathology and physiotherapy units. Data collection tool and procedure The data were collected by using structured checklist Study population which was adapted from different literatures [ 11, 16, 17]. All registered children diagnosed with cancer at univer- The tool was prepared in English version and the data sity of Gondar comprehensive specialized hospital admit- were extracted through reviewing patient’ medical chart ted to pediatric oncology ward from January 1, 2019 to by trained data collectors. Two BSc clinical nurses and December 31, 2021. one BSc nurse (ward head) supervisor were participated for data collection. Inclusion criteria All medical records of children diagnosed with cancer Data Quality Control aged ≤ 18 years in pediatrics cancer unit at university of To assure the data quality, chart review was done on 5%( Gondar comprehensive specialized hospital from Janu- 10) of the study population to test the checklists’ struc- ary1, 2019 to December 31, 2021. ture, completeness and essential modifications were made accordingly at University of Gondar comprehen- Sample size techniques and sampling procedure sive specialized hospital. Cronbach alpha (0.75) was Since the total number of the population under investi- measured to check reliability of the tool. Face tool valida- gation was small (200), Census method was applied (all tion checked by experts; training for data collectors and registered children diagnosed with cancer at university of supervisor was given prior to data collection for half day. Gondar comprehensive specialized hospital admitted to pediatric oncology ward included as study population). Data processing and analysis According to pediatric cancer patients’ report from the The data were checked by the principal investigator on a registration book, on average 5.6 children have been vis- daily basis during data collection for completeness, and ited pediatric oncology ward per month and sixty seven consistencies. Collected Data were then coded, entered per year. Therefore, the study population size was all 200 to EPI data V4.6, cleaned and analyzed using STATA medical charts of children diagnosed with cancer who version 14.00 Software. Descriptive analysis was used to were registered from January 1, 2019 to December 31, describe the frequencies and percentages of the variables 2021. in the study. The strength of association was measured using adjusted odds ratio and 95% confidence interval. Variables of the study Binary logistic regression analysis was used to test associ- Dependent variable: Delay in Diagnosis. ations between independent variables and the dependent variable. Variables with P-value < 0.25 in bi-variable anal- Independent variables ysis were included to the multivariable logistic regres- Socio-demographic characteristics of child (sex, age, sion model. Finally, variables with P-value < 0.05 were residence, health insurance). considered as potential determinants of delayed diagno- Clinical characteristics (sign/symptom, type of malig- sis among pediatric cancer patients. The Hosmer-Lem - nancy, comorbid illness). eshow logistic regression model was fitted at (x = 10.36; Health care associated characteristics (first visited p = 0.241). facility, hospital level, referral, source for referral, medical specialty of care provider). Results Socio-demographic characteristics of study participants Operational definition A total of 200 participants were included in the study Delay in diagnosis The time interval between cancer with newly diagnosed malignancy making response rate manifestations detected to confirmed diagnosis (if median of 100%. About 131 (65.5%) of the study participants diagnosis time ≥ 90 days it is delayed) [16]. were males. The median and interquartile range (IQR) of participants’ age was 7 ± 6 years in which most of them were found in the age category of 5–10 years. Majority Gardie et al. BMC Cancer (2023) 23:469 Page 4 of 7 Table 1 Socio-demographic characteristics of study participants with cancer in UOGCSH, Gondar, North West, Ethiopia, 2022(N = 200) Variables Frequency (N) Per- cent (%) Sex Male 131 65.5% Female 69 34.5% Residence Rural 76 38% Fig. 1 Health care providers’ specialty and first contact evaluation at can - Urban 124 62% cer treatment center at University of Gondar Comprehensive Specialized Health insurance Hospital, North West, Ethiopia, 2022 (N = 200) Yes 88 44% No 112 56% Age < 5 years 64 32% 5–10 years 87 43.5% 10-≤18 years 49 24.5% Table 2 Health care system literacy of caregivers among children with cancer in UOGCSH, Gondar, North West, Ethiopia, 2022(N = 200) Variables Delayed diagnosis Yes No First visited facility Fig. 2 Delay in diagnosis of cancer among children based on type of can- Health center 11 (5.5%) 10 (5%) cer in University of Gondar comprehensive specialized hospital, Gondar, Hospital 70 (35%) 92 (46%) North West Ethiopia, 2022 (N = 200) Private clinic 7 (3.5%) 10 (5%) Referral 42 (21%) 158 (79%) Health care providers’ specialty and first contact evaluation Source of referral at cancer treatment center Health center 3 (7.14%) 10 Most patients 171(85%) were initially evaluated by intern (23.81%) doctors, 17(8.5%) evaluated by resident physicians. Hospital 1 (2.38%) 17 Weight loss 63(31.5%), pain 46(23%), abdominal mass (40.48%) 42(21%) and eye related sign/symptoms 12(6%) were pre- Private clinic 4 (9.52%) 7 (16.67%) senting common signs/symptoms among children with Hospital level cancer. Around 85(42.50%) of children with cancer had Primary hospital 17 (10.49%) 30 (18.52%) comorbid disease while the rest had not (Fig. 1). General hospital 15 (9.26%) 13 (8.02%) Specialized hospital 37 (22.84%) 50 Delay in diagnosis of cancer among children age ≤ 18 years (30.86%) admitted at oncology ward From the total of 200 patients, 88 (44%) [CI; 37-51%] had 124(62%) of the participants were urban residents. delayed diagnosis in which the majority of the delayed in 88(44%) of respondents had health insurance (Table 1). diagnosis (50%) was contributed by patients’ delay. Clinical/Health care-related characteristics of participants Delay in diagnosis of cancer among children depened on Majority of pediatric patients’ first contact with health the type of cancer care providers 162(81%) cases had seen in hospital, The most common malignancy were ALL 50 (25%) fol - 42(21.0%) of children had referral paper and most of lowed by Wilms tumor 37(18.5%) and NHL 28(14%). them were from specialized hospital 87(53.7%) (Table 2). Patients who had Wilms tumor were more delayed to be diagnosed (Fig. 2). Gardie et al. BMC Cancer (2023) 23:469 Page 5 of 7 Factors associated with delay in diagnosis of cancer among Acute Lymphoblastic leukemia and those who had Reti- children noblastoma were 4.1 (AOR = 4.09; 95%CI = 1.29–13.02) In the bi-variable analysis, sex, referral, residence, health times more likely delayed diagnosis than who had Acute insurance, comorbid disease, HL, NHL, Wilms tumor and Lymphoblastic leukemia (Table 3). Retinoblastoma were factors that had a p-value < 0.25. Variables that had a p-value of < 0.25 in the bi-variable Discussion analysis were further analyzed using multivariable logis- The aim of this study was to identify delay in diagnosis tic regression. The results of this analysis showed that and associated factors of pediatric cancer patients at uni- the area of residence, health insurance, referral, Hodgkin versity of Gondar Comprehensive Specialized Hospital. lymphoma, Retinoblastoma and comorbid disease were The overall current finding revealed that 44% of partici - found to be significantly associated with delayed diagno - pants had total delay in diagnosis. This finding is lower sis of cancer in children. than study conducted in Argentina(63.5%) and Bra- The odds of those children living in rural residence zil(55%) [18, 19]. This discrepancy might be due to dif - were 1.96 (AOR = 1.96; 95%CI = 1.08–3.58) times more ferences in sample size and included cancer type in the likely to get diagnose delayed relative to urban resi- study. dents. Similarly, the odds of children who have no health The current finding is also lower than the study con - insurance were 2 times (AOR = 2.21; 95%CI 1.21–4.04) ducted in Mekele (69.6%) and Bangladesh (70%) [16, 20]. more likely to be diagnosed delay as with compared to The difference might be due to shorter diagnosis time by those who have health insurance. Moreover, the odds physician in current study that enhances timely decision of children who had not comorbid disease were 2 times on pediatric cancer diagnosis, study period, cut off point (AOR = 2.1; 95%CI = 1.01–4.32) more likely to get delayed. in diagnosis delay and difference in socio-demographic Children having no referral had odds of 6.3 (AOR = 6.3; characteristics of the study participants. 95%CI = 2.15–18.55) times more likely delay in diagnosis Residence, referral, health insurance, comorbid disease, than children who had referral. Those who had Hodgkin Retinoblastoma and Hodgkin lymphoma cancers were lymphoma had odds of 9.4 (AOR = 9.36; 95%CI = 2.1- significant factors that contribute for diagnosis delay. 41.72) times more likely delay in diagnosis than who had Children with Retinoblastoma had odds of 4.1 times more likely delay to be diagnosed than children hav- Table 3 Factors associated with delay in diagnosis of cancer ing acute lymphoblastic leukemia keeping other vari- among children aged ≤ 18 years (UOGCSH), 2022(N = 200) ables constant. This finding is similar with that of the Variables Category Delay in Diagnosis COR AOR study done in Jimma comprehensive specialized hospi- (95%CI) (95%CI) Yes No tal and Nigeria [12, 21]. This similarity might be due to Sex Female 25(36.23%) 44(63.77%) 0.61(0.34– 1.14(0.13– a high risk of the cancer being missed on examination, 1.12)* 9.97) either because tumors are located in the anterior retina, Male 63(48.09%) 68(51.91%) 1 1 because the examination has not been done correctly, or Residence Rural 42(55.26%) 34(44.74%) 2.09(1.17– 1.96(1.08– because the child is unable to co-operate with the exam 3.74)* 3.58)** [22]. Urban 46(37.1%) 78(62.9%) 1 1 Likewise, in the current finding children having Hodg - Health Yes 30(34.09%) 58(65.91%) 1 1 kin lymphoma had odds of 9.4 times more likely delay to insurance No 58(51.79%) 54(48.21%) 2.1(1.17– 2.21(1.21– be diagnosed than children having acute lymphoblastic 3.69)* 4.04)** leukemia keeping other variables constant. This might Comorbid Yes 30(35.29%) 55(64.71%) 1 1 disease be the fact that some tests use specialized equipment No 58(50.43%) 57(49.57%) 1.9(1.05– 2.1(1.01– 3.32)* 4.32)** or need specially trained experts to find out the exact Cancer HL 12(80%) 3(20%) 9(2.23– 9.4(2.1- genetic make-up of lymphoma cells. The samples might type 36.33)* 41.72)** need to be sent to a different laboratory and can take sev - NHL 13(46.43%) 15(53.57%) 1.84(0.71– 1.54(0.54– eral times [23]. 4.77)* 4.38) From our Findings the risk of increased delay for chil- Wilms 19(51.35%) 18(48.65%) 2.24(0.93– 1.53(0.63– dren who were living in rural area was 1.96 times more 5.39)* 4.27) likely delay than urban residence keeping other vari- Retino- 14(68.18%) 8(31.82%) 3.94(1.38– 4.1(1.29– ables constant. the current finding is comparable with blastoma 11.25)* 13.03)** the study from Mekele Ayder Hospital [16]. This is due ALL 16(32%) 34(68%) 1 1 to rural areas might be far from cancer treatment center, Referral Yes 9(21.43%) 33(78.57%) 1 1 transport inaccessibility and parents’ low health seeking No 79(50%) 79(50%) 3.7(1.65– 6.3(2.15– 8.16)* 18.55)** behavior. N.B; *=p-value < 0.25 and **=p-value < 0.05 Gardie et al. BMC Cancer (2023) 23:469 Page 6 of 7 data, visualization, conceptualizationMulugeta Ayalew- Data curation, Children who have no health insurance had odds 2 methodology, supervision, investigation, validation, reviewing and editing dataYihenew Sewale- methodology, software, reviewing and editing data, times more likely to be diagnosed delay as with compared visualization, conceptualizationZelalem Feleke- methodology, software, to those who have health insurance. This is similar with reviewing and editing data, visualization, conceptualizationMelkamu Tilahun- a study done in Kenya and Mekele [10, 16]. Where have conceptualization, data curation, methodology, supervision, investigation, validation, reviewing and editing data. no insurance increased the risk of delayed in diagno- sis. Regarding the referral system, Children who had no Funding referral had odds of 6.3 times more likely delay in diag- This study was funded by Assosa University. However, the funder had no role in the data collection, analysis and preparation of the manuscript, and nosis of childhood cancer than children who had referral. publication decision. This finding is in line with the study conducted in Ibadan, Nigeria [21]. Data Availability Data generated/ analyzed during this study are found from the corresponding Moreover, Children who have no comorbid disease author. were 2 times more likely to be diagnosed delay as with compared to those who have comorbid disease keeping Declarations other variables constant. This might be due to patients having comorbid disease seeking more health care and Ethical statement We extracted anonymized medical records data for children with cancer may shorten delay in diagnosis of childhood cancer. ending between January 1, 2019 to December 31, 2021. University of Gondar is the main custodian of the registered health system and maintains the Limitation of the study system following ethical, legal privacy and confidentiality requirements. We obtained ethics approval from University of Gondar research review board, The study couldn’t incorporate parental socio-demo - college of medicine and health sciences, school of nursing (CMHSN Ethics graphic characteristics and opinions because of the Ref: 227/2022) (Date: 4 May 2022). Participant consent was not required as the nature of study design and secondary data usage. It may study used de-identified registry based secondary data. As long as the work does not violate the rights of individuals and does not include identifiable not be representative of the whole country cases as it is a information, University of Gondar permit researchers to access medical charts single institutional study. It is also difficult to determine without obtaining prior consent from participants to pursue research for strong cause and effect relationships between dependent the common good. Informed consent was waived by UOG’s research review board. This decision was in accordance with the National Research Ethics and independent variables since it is a cross-sectional Review Guideline, Sixth Edition, Chap. 7, Sect. 7.2, and was consistent with the study. Declaration of Helsinki. Consent to publish Conclusion and recommendation Not applicable. Although delays in diagnosis of cancer among children were relatively low as compared to other studies, the Conflict of interest All authors declared that they have no competing of interest in this study. prevalence of delay in diagnosis of cancer among chil- dren remains prevalent in the study area. Rural residence, Author details absence of health insurance, Hodgkin lymphoma, Reti- Department of Nursing, College of health sciences, Assosa University, Assosa, Ethiopia noblastoma, no referral and absence of comorbid were Department of medical nursing, School of Nursing, College of Health significant factors associated with delay in diagnosis of Sciences, University of Gondar, Gondar, Ethiopia childhood cancer. Therefore, it is recommended to con - Department of Midwifery, College of health sciences, Assosa University, Assosa, Ethiopia duct either large-scale community-based or qualitative Department of public health, College of health sciences, Woldia study to address those factors that hinder early diagno- University, Woldia, Ethiopia sis of cancer in children. It is also better to expand refer- Department of Pediatrics, School of Medicine, University of Gondar, Gondar, Ethiopia ral linkage, promote health insurance to patients and Department of nursing, College of health sciences, Debre Berhan children shall be evaluated more by senior health care University, Debre Berhan, Ethiopia providers. Department of pediatrics and child health nursing, School of Nursing, College of Health Sciences, University of Gondar, Gondar, Ethiopia Acknowledgements The authors thank the data collectors, data collectors’ supervisors and Received: 18 November 2022 / Accepted: 21 April 2023 administrative staff of University of Gondar comprehensive specialized hospital for their cooperation to conduct this research. We also extend our deepest gratitude to Assosa University and clinical staff of University of Gondar comprehensive specialized Hospital for their unreserved support. Without them this work would not be realized. Author Contribution References Yimenu Gardie- conceptualization, data curation, software, visualization, 1. Chukwu B, Ezenwosu O, Ikefuna A, Emodi I. Diagnostic delay in pediatric investigation, methodology, writing original dataMulugeta Wassie- cancer in Enugu, Nigeria: a prospective study. Pediatr Hematol Oncol. conceptualization, data curation, methodology, supervision, investigation, 2015;32(2):164–71. validation, reviewing and editing dataSeid Wodajo- conceptualization, 2. Cotache-Condor C, Grimm A, Williamson J, Kantety V, Landrum K, Schroeder software, methodology, investigation, validation, reviewing and editing K et al. Factors contributing to delayed childhood cancer care in low‐and dataMastewal Giza- methodology, software, reviewing and editing Gardie et al. BMC Cancer (2023) 23:469 Page 7 of 7 middle‐income countries: A systematic review protocol. Pediatr Blood 14. Hadley LG, Rouma BS, Saad-Eldin Y, editors. Challenge of pediatric oncology Cancer. 2022:e29646. in Africa. Seminars in pediatric surgery. Elsevier; 2012. 3. Little J. Epidemiology of childhood cancer. IARC scientific publications; 1999. 15. Ethiopia sCSA. statistics of Centeral North Gondar population. 2007. 4. De Camargo B, De Andrea MLM, Franco EL. Catching up with history: 16. Berhane A, Hailu T, Mulugeta A. Determinants of delayed diagnosis among treatment of Wilms’ tumor in a developing country. Med Pediatr Oncol. pediatric cancer patients from Ayder Comprehensive Specialized Hospital, 1987;15(5):270–6. Mekelle, Northern Ethiopia. BMC Pediatr. 2019;19(1):1–8. 5. Cordoba MA, Godoy N, Castaño A, Ribeiro KB, Moreno F, de Vries E. Childhood 17. Haimi M, Nahum MP, Arush MWB. Delay in diagnosis of children with cancer in Latin America: from detection to palliative care and survivorship. cancer: a retrospective study of 315 children. Pediatr Hematol Oncol. Cancer Epidemiol. 2021;71:101837. 2004;21(1):37–48. 6. Ministry of Health. ’s National Childhood and Adolescent Cancer Control Plan. 18. Moreno F, Loria D, Abriata G, Terracini B. Childhood cancer: incidence and childhood cancer. 2019. early deaths in Argentina, 2000–2008. Eur J Cancer. 2013;49(2):465–73. 7. Araz NC, Guler E. Delays in diagnosis of childhood cancer in southeastern 19. Lins MM, Amorim M, Vilela P, Viana M, Ribeiro RC, Pedrosa A, et al. Delayed Turkey and the associated factors. Pediatr Hematol Oncol. 2015;32(2):153–63. diagnosis of leukemia and association with morbid-mortality in children in 8. Brand NR, Qu LG, Chao A, Ilbawi AM. Delays and barriers to cancer care Pernambuco, Brazil. J Pediatr Hematol Oncol. 2012;34(7):e271–e6. in low-and middle‐income countries: a systematic review. Oncologist. 20. Begum M, Islam MJ, Akhtar MW, Karim S. Evaluation of delays in diagnosis 2019;24(12):e1371–e80. and treatment of childhood malignancies in Bangladesh. South Asian Journal 9. Stefan DC, Siemonsma F. Delay and causes of delay in the diagnosis of child- of Cancer. 2016;5(04):192–3. hood cancer in Africa. Pediatr Blood Cancer. 2011;56(1):80–5. 21. James B, Ajayi S, Ogun O, Oladokun R. Factors influencing time to diagnosis 10. Njuguna F, Martijn H, Langat S, Musimbi J, Muliro H, Skiles J, et al. Factors of childhood cancer in Ibadan, Nigeria Afr health Sci. 2009;9(4). influencing time to diagnosis and treatment among pediatric oncology 22. Dimaras H, Corson TW, Cobrinik D, White A, Zhao J, Munier FL, et al. Retino- patients in Kenya. Pediatr Hematol Oncol. 2016;33(3):186–99. blastoma Nat reviews Disease primers. 2015;1(1):1–23. 11. Abdelkhalek E, Sherief L, Kamal N, Soliman R. Factors associated with 23. Lester SC. Manual of Surgical Pathology: Expert Consult-Online and print. delayed cancer diagnosis in egyptian children. Clin Med Insights: Pediatr. Elsevier Health Sciences; 2010. 2014;8:CMPed. 12. Hordofa DF, Daba KT, Mengesha AA. Clinical Presentation of Retinoblastoma Publisher’s Note in Ethiopia: A Case of Jimma University Medical Center Pediatric Oncology Springer Nature remains neutral with regard to jurisdictional claims in Unit, Southwest Ethiopia. Ethiop J Health Sci. 2021;31(5). published maps and institutional affiliations. 13. Martin S, Ulrich C, Munsell M, Taylor S, Lange G, Bleyer A. Delays in cancer diagnosis in underinsured young adults and older adolescents. Oncologist. 2007;12(7):816–24.

Journal

BMC Cancer – Springer Journals

Published: May 22, 2023

Keywords: Delay in diagnosis; cancer; Children; Gondar; Ethiopia

There are no references for this article.