McGill researchers probing sources of delays, impact on treatment and prognosis
The causes behind the delayed diagnosis of childhood cancers may vary, but the impact of such delays on the children’s prognosis is not yet known, say two McGill University researchers who have conducted the first-ever review of studies on the topic.
Dr. Eduardo Franco, director of cancer epidemiology at McGill, and Mr. Tam Dang-Tan, an epidemiology PhD student, analyzed 23 studies conducted worldwide. In their findings, to be published in the August 15, 2007, issue of the American Cancer Society’s Cancer journal, they note that delayed diagnosis can be attributed to one of three sources: the patient or parent; the type or stage of the disease; and the health-care system itself.
“The main factors related to diagnosis delay were the child’s age at diagnosis, the parents’ level of education, the type of cancer, presentation of systems, tumor site, cancer stage and the first medical specialty consulted,” the researchers said, adding that a greater understanding is needed of these factors and their impact on the prognosis and severity of the disease.
Cancer is the leading cause of disease-related death among children in developed countries and because children are usually under the care of their parents, the parents’ knowledge, attitudes and behaviour in responding to a child’s cancer take on particular importance, the researchers noted, adding that parents do not, by any means, bear sole responsibility.
Reported wait times in the 23 studies varied widely, but were generally “not that bad,” said Dr. Franco; however, the studies indicated that physician-caused delays tended to be longer than those caused by delayed parental or patient recognition of disease. The researchers suggest this could be because a complex chain of events is triggered once a patient with cancer enters the health-care system. For instance, in some cases, the sheer complexity of a patient’s cancer could lead to a delay attributable to the health-care system, they said.
“After the patient is taken to a health-care provider, the responsibility falls on the health-care system to be swift in order to ensure timely diagnosis and treatment,” Dr. Franco said.
Dr. Franco and Tam Dang-Tan conducted the review, funded by the Canadian Institutes of Health Research (CIHR), as a prelude to their own research on diagnostic delay times for childhood cancers within the Canadian health-care system, a study that will involve thousands of patients from all provinces. They hope to publish the initial results of that research later this year.
“Our Canadian study is going to look at a lot of the details not covered [in the 23 international studies], looking at whether these delays are causing harm,” said Dr. Franco.