title: Delays in diagnosis of pediatric solid tumors in Singapore.
abstract: OBJECTIVE
  To investigate social, clinical, and disease-related factors associated with diagnostic delay.
  
  
  METHODS
  Two-hundred and 9 solid tumor cases reported to the Singapore Childhood Cancer Registry at KK Hospital between 1997 and 2007 were reviewed retrospectively. The natural logarithms of total delay times were correlated with social, clinical, and disease factors using univariate and multivariate analysis. Subanalysis was performed for the periods before and after first healthcare contact, which were defined as parental and physician delay, respectively.
  
  
  RESULTS
  Mean total delay was 11.6 weeks. Mean parental and physician delay was 7.7 and 4.0 weeks, respectively. Shorter delay was associated with younger age (P<0.05), incidental detection by healthcare workers (P<0.001), and first presentations to pediatricians and nonpediatric emergency departments (P=0.01). Tumor type (P<0.01) and site (P=0.001) were also significantly related. After adjustment for other factors, extracranial germ cell tumors, abdominal tumors and first presentation to nonpediatric emergency departments were significantly associated with shorter total delay. Disease stage remained constant over time, with 30% presenting in stage 4.
  
  
  CONCLUSIONS
  Patient age, first healthcare contact, tumor type, and site were significantly related to diagnostic delay in pediatric solid tumors. Our findings reflect factors related to delay in an urban island-state with minimized confounding by healthcare access and geographic factors.
authors.affiliation: Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore. amos.loh.h.p@singhealth.com.sg
authors.forename: Amos Hong Pheng
authors.initials: AH
authors.lastname: Loh
authors.forename: Christina
authors.initials: C
authors.lastname: Ha
authors.forename: Joyce Horng Yiing
authors.initials: JH
authors.lastname: Chua
authors.forename: Wan Tew
authors.initials: WT
authors.lastname: Seow
authors.forename: Mei Yoke
authors.initials: MY
authors.lastname: Chan
authors.forename: Ah Moy
authors.initials: AM
authors.lastname: Tan
authors.forename: Chan Hon
authors.initials: CH
authors.lastname: Chui
mesh_terms: D000367:Age Factors; D003695:Delivery of Health Care / Q000592:standards*; D055088:Early Detection of Cancer; D006268:Health Facilities; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis*; D010290:Parents; D010820:Physicians; D012189:Retrospective Studies; D012846:Singapore; D012959:Socioeconomic Factors; D013997:Time Factors