الفهرس 
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Abstract
The current study was planned to ascertain lag time till diagnosis, and then till treatment in pediatric patients with hemato-oncologic malignancy and to determine potential factors influencing the delayed diagnosis of cancer and relate time to diagnosis with overall and event-free survival rates.
A cross sectional study including 115 children and adolescent less than 18 years with confirmed diagnosis of cancer. With confirmed cancer diagnosis was conducted in Pediatric Hematology –Oncology clinic, Children’s hospital Ain Shams University, Egypt. A predesigned questionnaire was structured to collect data from parents/legal guardians of children diagnosed with cancer including the demographic data, data about cancer including presenting symptoms, site, risk, modalities of diagnosis, time to diagnose, duration of overall and event free survival.
Our results revealed that 59.1% of patients have got confirmed hematological malignancy and 40.9% were diagnosed with solid malignancy. The most common hematological malignancy found was Acute Lymphoblastic leukemia (ALL) representing 41.7% while the most common solid tumor was neuroblastoma representing 10.4%.
Median total diagnostic delay or Lag Time (LT) for all patients was 53 (IQR 25-103) days. Median patient/parent delay was 2 (1-10) days, median referral delay was 30 (10-67) days. Median diagnosis delay was 7 (3-17)) days, and median physician delay (referral + diagnostic delay) was 37 (16-90) days. The median treatment delay was 2 (1-4) days for different types of tumors. Health system delay (Physician delay + treatment delay) was 42(17-95) days.
Solid tumors had longer diagnosis delay and total diagnostic delay than hematological malignancies. Wilms tumor had the shortest median LT of 30.5 (16.5-232) days) whilst retinoblastoma had the longest 129.5 (76 - 286) days).
Median lag time was the short in cancer originating from bone marrow or renal tissue, whereas if primary tumor site was in the eye, the LT was long. Also, a significant difference was observed in median parent delay between different sites of cancer (p=0.005), where the longest was in patients with tumor originating from eye. Long lag time was associated with presence of metastasis.
Presence of misdiagnosis was associated with long median lag time; 97 days versus 42 days.
A significant delay in diagnosis was observed in patients coming from rural regions (p = 0.043). Also, a significant delay in referral and total diagnosis time was observed in patients who were referred from other countries (p=0.005 and 0.000 respectively). Positive correlation between parent delay and total diagnostic delay, and between referral delay and total diagnostic delay.
Patients’ gender, age or socio-economic status did not significantly affect the median total diagnostic delay.
There was no correlation between overall survival or event-free survival and total diagnostic delay.