title: Factors associated with delayed cancer diagnosis in egyptian children.
abstract: BACKGROUND
  Despite tremendous importance of early cancer diagnosis in children, few studies on this topic have been conducted in Egypt. Early stage diagnosis can have a positive effect on prognoses and the quality of life of children with cancer. We investigated delays in the diagnosis of childhood cancers in Egypt and determined the factors associated with these delays.
  
  
  METHODS
  This retrospective study included 172 children with cancer from two pediatric oncology units. The interval between symptoms onset and final diagnosis for each child was estimated and examined by univariate and multivariate analyses to determine correlations with the child's sex, age at diagnosis, type and site of malignancy, family residence, socioeconomic status, and parental educational level.
  
  
  RESULTS
  The median total diagnosis delay period was 47 days caused by patients and/or parents (8 days) and diagnosis (28 days). Statistically significant patient factors associated with delayed diagnosis were age (<5 years), lower parental education, and socioeconomic status. Sex residence and family size were not significant. Malignancy type and tumor site significantly affected the time for diagnosis. The lowest median value was associated with germ cell tumors (GCTs) and leukemia, and the highest value was in children with brain tumor. Missed diagnoses were initially recorded in 39.5% of the patients and were associated with patient and tumor factors.
  
  
  CONCLUSIONS
  Delayed diagnosis of childhood cancer is related to age, family, socioeconomic status and parental education, and cancer type and site. Efforts should be made to promote awareness, develop effective steps to eliminate possible contributing factors, and determine the best intervention method.
authors.affiliation: Pediatric Department, Faculty of Medicine, Zagazig University, Egypt. ; Pediatric Department, Banha Children's Hospital, Egypt.
authors.forename: Er
authors.initials: E
authors.lastname: Abdelkhalek
authors.affiliation: Pediatric Department, Faculty of Medicine, Zagazig University, Egypt. ; Pediatric Department, Banha Children's Hospital, Egypt.
authors.forename: Lm
authors.initials: L
authors.lastname: Sherief
authors.affiliation: Pediatric Department, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Nm
authors.initials: N
authors.lastname: Kamal
authors.affiliation: Clinical Research Specialist, Children's Cancer Hospital, Egypt.
authors.forename: Rm
authors.initials: R
authors.lastname: Soliman
keywords: Egypt; cancer; children; delayed diagnosis