Delay in Diagnosis Key Factor in India’s Childhood Cancer Burden: Study
The 'Access India Study' reveals that the total interval time from the onset of symptom to commencement of treatment is 56 days.
Cancer is the leading cause of death worldwide, accounting for about 10 million deaths in 2020.
While it is generally considered a disease of the adults, India has a huge burden of cancer cases among children less than 15 years of age, since they comprise more than a third of the population.
The proportion of childhood cancers can be up to 5 percent of all cancer burden in the country.
It is estimated that worldwide there are about 400,000 new cases of cancer occurring in children aged below 19 every year, out of which nearly 76,805 cases occur in India, according to the World Health Organisation (WHO).
Around 50 percent of the children in India remain undiagnosed and have no access to treatment. Those who do access care, often present with an advanced stage of disease and a lower probability of cure, the study states.
About the Study
The study was conducted between 1 July, 2019 in the first 28 February, 2021.
The doctors analysed the time intervals between the onset of symptoms, first visit to healthcare providers, diagnosis and treatment for 2,877 children registered across 71 centres in 19 states, and 37 cities across north and northeastern India.
The survey as done by the Indian Paediatric Oncology Group (InPOG) and supported by Cankids Kidscan, a national society for childhood cancers, and other non-government organisations.
Long Route to Treatment
The study found that on an average, parents reach healthcare professionals within three days of the first symptom in childhood cancer cases.
However, the major delay is at the Diagnostic Interval – first presentation to a healthcare provider to diagnosis. Here, on an average, it takes them 37 days to navigate the primary and secondary healthcare system before they reach the specialist hospital and get a diagnosis.
Once the cancer is diagnosed, the treatment interval – diagnosis to the treatment to start – doesn’t take more than three days.
Total interval from onset of symptom to commencement of treatment is 56 days, the study says.
"Childhood cancer is a relatively rare disease, where the facilities for treatment may not be available everywhere. So, families have to travel a considerable distance before they can get diagnosed," said Ramandeep Arora, a consultant paediatric oncologist, InPOG member and the study’s lead investigator.
The study also found that the three most common cancers were blood cancer, bone and soft tissue sarcomas, and lymphomas.
These studies have shown that late diagnosis is associated with poor outcomes.
"If you are diagnosed in time, and you take treatment in time, then hopefully, the disease is caught at an earlier stage. This means that you have an higher chance of cure, need lesser treatment, have less side effects and expenses," Dr Arora says..
While there are multiple factors that determine the time lag in diagnosis and treatment of childhood cancers, what's important is access to information.
What would you do when you want to book a flight? You go to a verified website and look for flights according to your destination, isn't it? Looking for cancer centres and hospitals should be as easy as that, Dr Arora says.
"The stakeholders of childhood cancer, need to come up with a list of all the centres in the country. The information should be available in verified government and non-government portals."
"The healthcare system-related delays are the major contributor to the overall delay. To achieve the standard of access to care and to address the factors associated with these delays there is a need for evidence-based planning at a large scale," the study adds.
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