DOI: 10.1200/go-26-13700 ISSN: 2687-8941

The Silent Clock: Time From First Symptoms to Diagnosis in Childhood Cancer in Egypt

Sonia Ahmed, Mariam Elsherif, Mona Fakhry, Hisham Moneib, Omneya Hassanain, Alaa El Haddad, Noha Sharafeldin
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PURPOSE

Early diagnosis and timely referrals to specialized pediatric oncologic care are essential for improving childhood cancer outcomes in LMICs. This study aimed to characterize patterns and determinants of diagnostic delays in children presenting with symptoms suggestive of cancer in Egypt.

METHODS

Prospective study (January 2024-April 2025) in children aged ≤18 years presenting to the screening clinic at Children's Cancer Hospital Egypt, a pediatric oncology center managing 40%-50% of childhood cancer cases nationwide. Parents or legal guardians completed a survey including sociodemographic characteristics, travel time, initial consultation with a non-specialist healthcare provider, pre-diagnosis treatments, and provisional diagnosis. Lag time was defined as the interval from symptom onset to diagnosis and stratified into patient delay (symptom onset to first medical consultation) and physician delay (first consultation to diagnosis). Robust linear regression models identified factors independently associated with diagnostic delays.

RESULTS

The study included 904 children, median age 7 years; 55.9% boys, 15.8% of guardians were illiterate, 29.2% had college education or higher, 24.6% had family size ≥6, and 27.7% had travel time ≥1 hour. The majority (95.4%) sought prior medical consultation (72.9% private physician/hospital, 22.0% public hospital), 35% received a prior alternate diagnosis. Provisional diagnoses included hematologic malignancies (25.5%), CNS tumors (27.2%), solid tumors (22.5%), and non-malignant conditions (14.1%). Median delay was total: 44 days, patient 4 days, and physician 27 days. Children aged 5-10 years and >10 years experienced 33% ( P = .02) and 93% ( P < .001) longer delays compared to those <5 years. Children living 60-120 minutes from CCHE experienced 29% longer delays than those within 60 minutes ( P = .02). Compared to children diagnosed with non-malignant conditions, hematologic malignancies had the shortest delay, followed by solid and CNS tumors. Age >10 years was associated with longer patient delay and prior alternate diagnosis was associated with longer physician delay.

CONCLUSION

Older age and longer travel time to a specialized center were significantly associated with longer delays. Prior alternate diagnosis was the strongest modifiable predictor of physician diagnostic delay. Targeted physician education on cancer awareness and early recognition, particularly in primary and secondary care settings, could reduce diagnostic delay and prompt earlier referral.

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