P2B234: The Long Journey of Pediatric Patients with Cancer in a Mexican Cohort

Background: Globally, childhood cancer is a significant cause of morbidity and mortality, unfortunately neglected. Approximately 300 000 children and adolescents around the world are diagnosed with cancer each year and almost 100 000 die from cancer. Leukemia is the most common cancer. Timely diagnosis and early treatment are essentials components of oncology that translate to better outcomes. In developed countries, overall survival rates have improved to 80-90%; nevertheless, almost cases occur in LMIC countries, where reported survival rates are lower.There is not much information reported about cancer incidence in Mexican children, but delayed presentation and advanced disease at diagnosis are common features. The latency between onset of symptoms and treatment could be multifactorial, related to social, cultural, financial, parental and healthcare associated factors. The literature about this topic is scarce in childhood cancer.

Methods: The primary aim of this study was to determine the time passed since debut of symptoms to first medical contact, diagnosis and treatment. We compared latency to treatment and diagnosis with some international data.

Results: In our cohort, 30 patients were included in the final analysis. The mean age at diagnosis was 9.5 +/- 6.2 years and 53% were women. The most common cancer was leukemia (70%), followed by solid tumors (brain tumors, germ cell tumors, bone and soft tissue sarcoma, wilms tumor and hepatoblastoma). 90% lived in urban areas. About their parents, 30% had an education degree lower than university, 63% were married, 20% divorced and 17% single. The time from symptom onset until the patient attended a healthcare provider was a mean of 32 days (1 – 370 days), 67 days (5 – 375) to receive a diagnosis, and 78 days (10 – 378) to first treatment. The most frequent initial symptoms were fever, pain and fatigue. Only 30% were initially evaluated by a pediatrician. The patients seen an average of 3 (range 1 – 9) different health care providers before receiving the correct diagnosis. At this time, 83% (25/30) of patients are live and unfortunately 17% (5/30) died.

Conclusion: In our study, the various time intervals related to diagnosis and treatment were longer than those reported from the developed countries. Its vital to understand the factors that influence interval times in diagnoses so that policies and programs can be implemented to improve medical care for children with cancer. The educational status of the parents, decentralization of cancer care, increasing the number of pediatric oncology center, awareness among primary care physicians and pediatricians about the signs and symptoms of malignancy can help in avoiding an undue delay in the diagnosis and treatment. Increasing the awareness about childhood cancer may help in achieving an early diagnosis and providing early treatment, thereby improving the outcomes in our country.