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LETTERS TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 168-169

Health-care system-related factors are the major contributors to time to diagnosis in solid tumors in children in India


1 Quality Care Research and Impact Department, Cankids…Kidscan, Max Institute of Cancer Care, Max Super Speciality Hospital, New Delhi, India
2 Pediatric Oncology Disease Management Group, Max Institute of Cancer Care, Max Super Speciality Hospital, New Delhi, India

Date of Submission21-Jan-2021
Date of Decision30-Jan-2021
Date of Acceptance15-Feb-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Jyotsna Sharma
Quality Care, Research and Impact Department, Cankids…Kidscan, New Delhi - 110 057
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_12_21

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How to cite this article:
Maji I, Sharma J, Arora RS. Health-care system-related factors are the major contributors to time to diagnosis in solid tumors in children in India. Cancer Res Stat Treat 2021;4:168-9

How to cite this URL:
Maji I, Sharma J, Arora RS. Health-care system-related factors are the major contributors to time to diagnosis in solid tumors in children in India. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 23];4:168-9. Available from: https://www.crstonline.com/text.asp?2021/4/1/168/312060



Timely diagnosis and initiation of treatment are essential for the optimal management and outcome of childhood cancers. A delay in diagnosis can lead to advanced-stage disease and poor outcomes. Factors influencing the time to diagnosis (TTD) can be patient-related (period from onset of symptoms to first health-care contact, usually in the primary health-care) or health-care-related (period from the first visit to a health-care facility to diagnosis, including all the touchpoints that a patient encounters in the health-care system).

This is an under-researched area in India, with most previous publications focusing on leukemias and brain tumors.[1] To the best of our knowledge, there has been only one previous study[2] that focused on the TTD and treatment in children with solid tumors. Therefore, the recent study by Singh et al. is a welcome addition.[3] This study was conducted in the outpatient department of pediatric oncology of the Kidwai Memorial Institute of Oncology (Karnataka, India) on 75 patients with solid tumors aged <15 years. The reported median TTD was 76 days, of which the time taken from symptom onset to the first visit to a health-care facility was 7 days (9.2% of the total TTD); navigating the health-care system and arriving at a diagnosis contributed to the remaining 89.8% of the total TTD. A comparison of the contribution of health-care system-related factors to the total TTD for three solid childhood malignancies between India and high-income countries is presented in [Table 1].[4]
Table 1: Time to diagnosis and relative contributions of health-care system-related factors in India and high-income countries

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This comparison shows that the median TTD for solid cancers in India is around twice that of high-income countries. It also highlights the stark difference in the contribution of factors related to the health-care system to TTD, which is reported to be around 90% in India and 30%–40% in high-income countries. This highlights the need for interventions at various steps from the first contact with a health-care provider to the final diagnosis to reduce the overall delay in diagnosis and improve the outcome of childhood cancers in low- and middle-income countries like India.

There is a paucity of data on TTD and its associated factors in India. Considering the need to generate more evidence, our next study is aimed at understanding the pathways for access to care for children with cancer for which we are currently recruiting children with cancer from North, Central, and East India. We also wish to identify the impact of these pathways on the disease and its outcomes. This study could potentially be one of the largest in the world in this area.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Faruqui N. Accessing Childhood Cancer Care in the Era of Universal Health Coverage: Insights from India. (Doctoral Thesis, Sydney School of Public Health, Faculty of Medicine and Health the University of Sydney); 2019. Available from: https://hdl.handle.net/2123/21884. [Last accessed on 2021 Feb 15].  Back to cited text no. 1
    
2.
Verma N, Bhattacharya S. Time to diagnosis and treatment of childhood cancer. Indian J Pediatr 2020;87:641-3.  Back to cited text no. 2
    
3.
Singh S, Kumar A, Kumar N, Kaushik PS, Akkineni V, Appaji L. First symptom and time to diagnosis in pediatric patients with solid tumors: A cross-sectional study from a regional cancer institute in South India. Cancer Res Stat Treat 2020;3:716-23.  Back to cited text no. 3
  [Full text]  
4.
Brasme JF, Morfouace M, Grill J, Martinot A, Amalberti R, Bons-Letouzey C, et al. Delays in diagnosis of paediatric cancers: A systematic review and comparison with expert testimony in lawsuits. Lancet Oncol 2012;13:e445-59.  Back to cited text no. 4
    



 
 
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