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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 169-170

Authors' reply to Maji et al.

Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

Date of Submission09-Feb-2021
Date of Decision22-Feb-2021
Date of Acceptance05-Mar-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Saksham Singh
Senior Resident, Department of Pediatric Oncology, KMIO, Dr M.H.Marigowda Road, Bengaluru(56002)
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_36_21

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How to cite this article:
Singh S, Kaushik PS, Kumar N. Authors' reply to Maji et al.. Cancer Res Stat Treat 2021;4:169-70

How to cite this URL:
Singh S, Kaushik PS, Kumar N. Authors' reply to Maji et al.. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Jun 21];4:169-70. Available from: https://www.crstonline.com/text.asp?2021/4/1/169/312091

We thank Maji et al.[1] for their comments on our article titled, “First symptom and time to diagnosis in pediatric patients with solid tumors: A cross-sectional study from a regional cancer institute in South India.”[2] Delay in diagnosis is one of the most important health-care-related causes of morbidity in patients with cancer. We observed that various factors related to the patients, their caregivers, health-care workers, and the disease itself could lead to a delay in diagnosis. The various pre-diagnostic time intervals observed in our study were longer than those reported from the developed countries.[3] In addition, we observed that physician delay was significantly longer than parental delay; similar findings have been reported by other studies.[3],[4] In our study, we assessed the factors affecting parental delay and physician delay separately. We found that parental delay was affected by the educational status of the mother as well as the tumor site and type, physician delay was affected by the stage of the tumor, and the total time to diagnosis was affected by the geographical distance from our cancer care center. Thus, creating awareness among the general public and pediatricians regarding childhood cancers and their early signs and symptoms, decentralization of cancer care, increasing the number of cancer centers to ease the access to care, and strengthening the screening system can help in avoiding undue delays in the diagnosis of childhood cancers. Although similar studies have been performed in the developed countries,[5] our study is second only to the study by Verma et al. from India to assess factors associated with diagnostic delays in pediatric patients with solid tumors.[4] The limitations of our study include the heterogeneity of the study cohort and the resultant small sample size for specific tumor types. Hence, an association of the delay in diagnosis with the outcomes could not be assessed. Besides the educational status of the mother, the socioeconomic status might have affected the delay in diagnosis; therefore, a scale such as the Kuppuswamy scale should have been included. We welcome the study by Maji et al. aimed at understanding the pathways for access to cancer care and identifying the impact of these pathways on the disease and its outcomes in a large cohort.[1] The role of the patients' financial status, health-care workers at the grassroot level like the Accredited Social Health Activitists (ASHA) Anganwadi workers and community health officers, as well as other factors that lead to parental delay such as the use of alternative medicines and time taken by the parents to visit the referral institute can also be explored in the study.

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There are no conflicts of interest.

  References Top

Maji I, Sharma J, Arora RS. Health-care-system-related factors are the major contributor to time to diagnosis in solid tumors in children in India. Cancer Res Stat Treat 2021;4:168-9.  Back to cited text no. 1
  [Full text]  
Singh S, Kumar A, Kumar N, Kaushik PS, Akkineni V, Appaji L. First symptom and time to diagnosis in pediaric 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. 2
  [Full text]  
Haimi M, Peretz Nahum M, Ben Arush MW. Delay in diagnosis of children with cancer: A retrospective study of 315 children. Pediatr Hematol Oncol 2004;21:37-48.  Back to cited text no. 3
Verma N, Bhattacharya S. Time to diagnosis and treatment of childhood cancer. Indian J Pediatr 2020;87:641-3.  Back to cited text no. 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. 5


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