Diagnostic Delays in Childhood Haematological Malignancies: Experience From a Lower-Middle-Income Country
Colambage Dona Gayashani Prabodhya, Maheeka Seneviwickrama, Sriyani Ranasinghe, Manori Gamage, Sashini Shehana Denagamagei, Mahendra SomathilakaPURPOSE
Diagnostic delays contribute to unfavourable outcomes of childhood haematological malignancies (CHM). These delays could occur at the patient, physician and system level. Compared to high-income countries, diagnostic delays are more prevalent in low and middle-income countries. Understanding the magnitude of these delays is essential for identifying and rectifying gaps in diagnostic pathways. There is a paucity of research related to diagnostic delays in CHM in Sri Lanka, a lower-middle-income country. The present study was designed to address this research gap.
METHODS
A retrospective cross-sectional study was conducted among 323 patients with CHM who presented to the National Cancer Institute, Sri Lanka's national cancer referral centre. Patients with incomplete medical records or missing symptom onset and diagnosis dates were excluded. Data were collected using medical record review and caregiver interviews with an interviewer-administered questionnaire. Diagnostic delay was defined as >90 days between the onset of cancer manifestations and confirmed diagnosis. Patient delay was defined as >50 days between symptom onset and the first healthcare visit. Physician delay was defined as >30 days from the first healthcare provider contact to confirmed cancer diagnosis. Data were analysed using SPSS V26 and presented as percentages and medians with IQRs.
RESULTS
The majority were male (66.6%, n= 215) diagnosed with acute lymphoblastic leukaemia (83.6%, n= 270), with a mean age of 91.39 months (SD=53.79). Diagnostic delay was experienced by 13.3% (n= 43; median= 27.5 days [IQR= 40]). Patient delay was observed in 9.3% (n=30; median= 7 days [IQR= 15]). Physician delay was the most common delay, observed in 21.0% (n= 68; median= 13 days [IQR: 20]), indicating greater variability and a larger contribution to overall diagnostic delay. Among the patients with diagnostic delay, fever was the most common presenting symptom (n= 21, 48.8%), followed by localised nodes (n= 10, 23.3%), and pain (n= 7, 16.3%).
CONCLUSION
Physician delay accounts for the larger component of the diagnosis delays in CHM. Improving early recognition, timely referral, and diagnostic efficiency may help reduce delays in CHM and improve outcomes.