title: Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya.
abstract: Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment. Study participants were parents of childhood cancer patients diagnosed between August 2013 and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9-1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days; P < .001). Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media.
authors.affiliation: a Department of Child Health and Pediatrics , Moi University , Eldoret , Kenya.
authors.forename: F
authors.initials: F
authors.lastname: Njuguna
authors.affiliation: b Department of Pediatric Oncology-Hematology, Doctor 2 Doctor Program , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Martijn
authors.affiliation: a Department of Child Health and Pediatrics , Moi University , Eldoret , Kenya.
authors.forename: S
authors.initials: S
authors.lastname: Langat
authors.affiliation: a Department of Child Health and Pediatrics , Moi University , Eldoret , Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Musimbi
authors.affiliation: a Department of Child Health and Pediatrics , Moi University , Eldoret , Kenya.
authors.forename: H
authors.initials: H
authors.lastname: Muliro
authors.affiliation: c Division of Hemato-Oncology , Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: J
authors.initials: J
authors.lastname: Skiles
authors.affiliation: c Division of Hemato-Oncology , Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: T
authors.initials: T
authors.lastname: Vik
authors.affiliation: d Department of Pediatrics , Dr. Sardjito Hospital , Yogyakarta , Indonesia.
authors.forename: M N
authors.initials: MN
authors.lastname: Sitaresmi
authors.affiliation: e Department of Epidemiology and Biostatistics , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: van de Ven
authors.affiliation: b Department of Pediatric Oncology-Hematology, Doctor 2 Doctor Program , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: G J L
authors.initials: GJ
authors.lastname: Kaspers
authors.affiliation: b Department of Pediatric Oncology-Hematology, Doctor 2 Doctor Program , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Mostert
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007348:Insurance, Health; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D013997:Time Factors
keywords: Childhood cancer; delay; low-income country