title: Influence of length of time to diagnosis and treatment on the survival of children with acute lymphoblastic leukemia: a population-based study.
abstract: The objectives were to describe times to diagnosis and initiation of treatment in pediatric ALL in Ontario from 1997 to 2007, and to measure their impact on OS and EFS. In 1000 children, the median times to diagnosis and treatment were both 1 day (IQR = 1-2). Those who began treatment >3 days after diagnosis had inferior OS (AHR = 2.49; 95% CI = 1.40-4.43; p = 0.002), and inferior EFS (AHR = 1.73; 95% CI = 1.01-2.96; p = 0.047) compared to those who began treatment ≤ 3 days after diagnosis. There was no statistically significant relationship between time to diagnosis and survival. Longer time to treatment was associated with worse survival in pediatric ALL; reasons for this relationship may be multi-factorial.
authors: Department of Pediatrics and Department of Internal Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada. Electronic address: bakerji@smh.ca.
authors: Jillian M
authors: JM
authors: Baker
authors: Program in Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors: Teresa
authors: T
authors: To
authors: Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors: Joseph
authors: J
authors: Beyene
authors: Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
authors: Brandon
authors: B
authors: Zagorski
authors: Pediatric Oncology Group of Ontario and Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors: Mark L
authors: ML
authors: Greenberg
authors: Division of Haematology-Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors: Lillian
authors: L
authors: Sung
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009864:Ontario / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D016019:Survival Analysis; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: AHR; ALL; Acute lymphoblastic leukemia; CI; Children; Delay; Diagnosis; EFS; IQR; OS; Treatment; acute lymphoblastic leukemia; adjusted hazard ratio; confidence interval; event-free survival; interquartile range; overall survival