Delay in diagnosis and treatment of childhood cancers in a developing country: A cross-sectional patient-based survey at country's largest pediatric oncology center.

Background & Objectives: Pediatric cancers have a huge survival gap between the high-income and the low-middle-income countries (LMICs). Despite various other causes, the advanced stage of presentation is a major contributing factor but limited data is available from developing countries in this regard. This study aimed to identify delay in treatment and factors associated with it in our setup. Methods: This was a Cross-Sectional survey conducted at the department of pediatric hematology-oncology Children Hospital Lahore using a questionnaire-based interview of parents of all newly diagnosed cases of pediatric cancers presenting to Pakistan's largest public-sector specialized center at the Children's Hospital Lahore, over two months, i.e. from December 1, 2023 to January 31, 2024. The data was analyzed using SPSS version 23.0. Results: A total of 119 new patients presenting to the hospital were included. The median total delay in treatment of children with cancer was 63 days which is less than comparable LMICs, but physician and healthcare system delay that makes up the major portion of the total delay is equivalent to some low-income countries. The patient delay was negligible. The statistically significant factors associated with delay were gender, age of the patient; and type of cancer. Whereas, the distance from the specialized center and the socio-economic status of the family did not contribute significantly. Conclusions: Healthcare system delay is a major contributor therefore strengthening the existing medical services, development of medical referral systems, and medical professional awareness and education can improve delays in treatment and outcomes in our setup.