International variation in child healthcare practices and implications for childhood cancer diagnosis: a scoping review and cross-country clinician survey.

Childhood cancer survival and stage at diagnosis vary internationally. Here, we explore differences in child health surveillance and healthcare practices across countries participating in the International Benchmarking of Childhood Cancer Survival by Stage (BENCHISTA) collaboration-with a focus on timely cancer diagnosis. We conducted a scoping review of five databases (MEDLINE, Embase, SCOPUS, Web of Science, and ProQuest Central) for articles published in English or Spanish between 1 Jan 2012 and 15 Oct 2025, describing child health surveillance and acute care pathways, limited to the 29 countries involved in the BENCHISTA collaboration. Two reviewers independently screened abstracts; a third resolved conflicts. In parallel, a semi-structured questionnaire was distributed (to one general practitioner, one paediatrician) in 27 countries who contributed to the BENCHISTA database. We collected standardised information on national child health practices and validated against published national guidance. Of 2,963 articles screened, 33 were included. Three key themes emerged: (1) healthcare-seeking behaviour of families and their interaction with frontline professionals, (2) awareness of alarm symptoms by caregivers and clinicians, and (3) system-level and training-related factors affecting timely diagnosis. Studies highlighted challenges such as low symptom recognition, variation in paediatric training, and limited referral guidance. Questionnaire responses showed variation in the number of routine child health checks with physical examination for children < 5 years (median 10; range 2-21), paediatric training, and access to diagnostic tools.

conclusionThere is substantial international variation in routine child health surveillance and acute illness assessment. These findings will inform interpretation of BENCHISTA data and may guide future strategies to support early cancer diagnosis. WHAT IS KNOWN: • Childhood cancer survival and stage at diagnosis vary internationally. • Early recognition of alarm symptoms is critical but often delayed due to system-level gaps. WHAT IS NEW: • This study combines a scoping literature review and clinician survey across 27 countries, identifying shared barriers to timely diagnosis. • It reveals variation in paediatric training of front-line healthcare practitioners, referral pathways, and child health surveillance practices, even among high-income countries.