title: Childhood cancer in developing society: A roadmap of health care.
abstract: BACKGROUND
  We assessed referral patterns of children with hematological malignancies (HM) in North India.
  
  
  METHODS
  The parents/guardians were interviewed at presentation, in the period between October 2001 and November 2002. Patient delay (symptom-contact), health system delay (contact-diagnosis), total delay (symptom-diagnosis), and number of contacts were compared between high- and standard-risk disease group.
  
  
  RESULTS
  Of the 79 children (55 boys; 69.6%) with HM, 47 (59.5%) had Acute Lymphoblastic Leukemia (ALL). Forty-four children had high-risk disease. The patient, system and total delay were a median of 2 days (with Interquartile range IQR of 1-6), 37 days (IQR 13-55), and 38 days (IQR 15-60) respectively. Majority of patients (64/79; 81%) went to private sector (non governmental health care providers) for health care. Number of contacts, which was the most significant, correlate with system delay.
  
  
  CONCLUSIONS
  Sensitizing the private sector practitioners about cancer in symptomatic children (pallor, bleeding, fever) may be effective.
authors: Department of Pediatrics, Govt. TD Medical College, Alappuzha, Kerala, India.
authors: P M
authors: PM
authors: Ramesh
authors: R K
authors: RK
authors: Marwaha
authors: T S
authors: TS
authors: Anish