Evaluation of factors affecting diagnostic delay in patients referred to the pediatric oncology clinic of Ankara University: A developing country model.
Journal of Clinical Oncology, cilt.44, sa.16, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 44 Sayı: 16
- Basım Tarihi: 2026
- Doi Numarası: 10.1200/jco.2026.44.16_suppl.e22010
- Dergi Adı: Journal of Clinical Oncology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO)
- Ankara Üniversitesi Adresli: Evet
Özet
Background: Early diagnosis is a major determinant of survival and treatment success in childhood cancers. However, diagnostic delay (DD) remains a significant public health problem, particularly in developing countries, and may lead to diagnosis at advanced disease stages. This study aimed to evaluate patient-, physician-, and healthcare system–related factors affecting DD among patients referred to the Pediatric Oncology Clinic of Ankara University Faculty of Medicine. Methods: This retrospective study included patients aged 0–18 years who were diagnosed with malignancy between 2003 and 2023. A total of 799 patients were analyzed. Data were obtained from patient medical records and discharge summaries, and missing information was completed through phone interviews. DD was categorized as patient-related, physician-related, and total delay. Evaluated factors included patient age and sex, parental education level, type of first healthcare facility visited, number and specialty of physicians consulted prior to diagnosis, presenting symptoms, and malignancy type. Statistical analyses were performed using Mann–Whitney U, Kruskal–Wallis, and chi-square tests, with p<0.05 considered statistically significant. The study was approved by the local ethics committee. Results: Patients aged 0–1 year were diagnosed earlier, whereas adolescents experienced significantly longer DDs (p<0.001). Maternal education level was significantly associated with DD (p=0.007). Mean DD was 20 days in children of university-educated mothers and 85 days in children of illiterate mothers. Paternal education level was not associated with DD. Patients initially presenting to a university hospital had shorter time to diagnosis than those presenting to secondary healthcare facilities (6 vs 15 days, p<0.01). Consultation with 1–3 physicians prior to diagnosis was associated with shorter DD (p<0.05). Bone tumors (17.8%), lymphoma (17.4%), and central nervous system tumors (11.7%) were associated with the longest DD and frequently required more than four physician visits. DD varied according to presenting symptoms. Nonspecific symptoms such as fever and fatigue resulted in delays of approximately 50 days in leukemia and 53 days in central nervous system tumors. In malignant bone tumors, extremity pain and swelling were associated with a DD of 70 days. Longer DD was associated with more advanced disease stage at diagnosis. Conclusions: DD in childhood cancers is a multifactorial process. Maternal education level, type of initial healthcare facility, and number of physicians consulted prior to diagnosis were the most influential factors. Longer DD was associated with advanced disease stage. Improving parental education, awarness and physician recognition of childhood cancers may contribute to earlier diagnosis and improved outcomes.