Hospital Delays For Pediatric Oncology Patients Under Scrutiny

This study was carried out in partnership with Health Canada and was recently published in Pediatric Blood and Cancer.

The study was conducted nationwide (except in Ontario) using the information system of the Canadian Childhood Cancer Surveillance and Control Program (CCCSCP), which gathers data from 17 pediatric oncology centres in Canada. The researchers analyzed the data of approximately 2900 patients aged 0 to 19 from the years 1995 to 2000.

"Overall, we have determined that it takes about one month to get a diagnosis from a pediatric oncologist from the time the first symptoms is identified," explained Tam Dang-Tan. "But we wanted to refine our analysis by splitting the total time into segments."

The researchers divided the time before the first pediatric oncology treatment into four segments or delays: from the appearance of the first symptoms to the visit with a general practitioner (patient delay); from the visit with the GP to the visit with an oncologist (referral delay); from the referral visit to the time of diagnosis; and finally from diagnosis to the time of initial treatment. Overall, the longest segments are the patient delay, which is dependent on individual factors, and the referral delay, which indicates a deficiency related to our health system. Once the patient comes under specialized care, however, things move quickly.

"We also noticed that the time to diagnosis decreased significantly over the five-year study period," explained Tam Dang-Tan. "This is probably due to better patient education and improved diagnostic techniques." Despite this general positive tendency, there are still disparities between different cancer types, as the symptoms of some cancers are not clear-cut and therefore not as easily detected. The researchers found that patient age also influenced treatment times, as the youngest patients tended to be diagnosed more quickly.

These results represent the first part of a study that aims to pinpoint the various factors that influence delays as well as the impact of wait times on patient prognoses. Once published in its entirety, the study should serve as a reference for decision-makers to help them issue recommendations to ensure that time to treatment is efficiently managed in our pediatric hospitals.

Tam Dang-Tan is a doctoral student in epidemiology and biostatistics who works under the supervision of Dr. Eduardo Franco.

This study was funded by the Canadian Institutes of Health Research (CIHR).