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Epidemiology

Timeliness of diagnosis and treatment: the challenge of childhood cancers

British Journal of Cancer volume 125, pages 1612–1620 (2021)Cite this article

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A Correction to this article was published on 16 September 2021

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Abstract

Cancer represents an important cause of disease-related death in children worldwide. Improved treatment and understanding of the ways in which cancer manifests has allowed for a greater prospect of survival in children of all ages. However, variation in childhood cancer experience exists based on factors at the individual, community and systems levels. Throughout the cancer care continuum these factors may influence the access and timeliness of care a child receives, leading to delays in diagnosis and treatment. The pejorative designation ‘delay in diagnosis and treatment’ is better characterised as lag time, representing an interval that is thought to influence survival and overall outcome. In recent decades, work has been done to expedite early childhood cancer diagnosis through the creation of screening and education-based programmes. Although systematic cancer screening in children poses risks and fails to achieve the goal of early diagnosis, a case has been made for risk-based surveillance that has been shown to improve outcome and reduce occurrence of advanced stage disease in targeted populations. The components of lag time are examined separately and individually. This review highlights the challenges of early diagnosis in childhood cancers and describes important contributors in the cancer care continuum.

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Fig. 1: Estimated incidence (numbers of cases, dark grey bars) of and mortality (numbers of deaths, light grey bars) from common paediatric cancers according to age group.
Fig. 2: Lag time in diagnosis and treatment according to patient, physician and healthcare system influences across the cancer treatment continuum.

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Data availability

The datasets analyzed during the current study are available from the GLOBOCAN and SEER data repositories at https://gco.iarc.fr/today and https://seer.cancer.gov/csr/1975_2018/

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Acknowledgements

We are grateful to Dr. Ligia Fu (Hospital Escuela, Tegucigalpa, Honduras), Dr. Carlos Rodriguez-Galindo (St. Jude Children’s Research Hospital, Memphis TN, United States), Dr. Kathy Pritchard-Jones (International Society of Paediatric Oncology, London, United Kingdom), Kathy Brodeur-Robb and Dr. Leah Young (C17 Children’s Cancer and Blood Disorders, Canada) and Dr. Lorna Fern (University College London, United Kingdom) for valuable suggestions and advice.

Funding

CM received an MSc. stipend from the Division of Cancer Epidemiology, McGill University. The other authors received no specific funding for this work.

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  1. Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada

    Callum J. R. Mullen & Eduardo L. Franco

  2. Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    Ronald D. Barr

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Mullen, C.J.R., Barr, R.D. & Franco, E.L. Timeliness of diagnosis and treatment: the challenge of childhood cancers. Br J Cancer 125, 1612–1620 (2021). https://doi.org/10.1038/s41416-021-01533-4

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