title: Delays in diagnosis and treatment of childhood cancer in Indonesia.
abstract: Emphasizing timely diagnosis and treatment of cancer are important themes in pediatric cancer management, as delays adversely impact survival. This study explores various delay types among children with cancer and determines factors that influence delays.
  
  
  
  This cross-sectional study was conducted at an Indonesian academic hospital. Parents of newly diagnosed patients were interviewed between October 2013 and September 2014 using semistructured questionnaires. Patient, physician, diagnosis, treatment, healthcare system (HCS), and total delay were analyzed.
  
  
  
  Parents of 145 children (response rate 89%) with cancer were interviewed. Median total delay was 70 days (range 5-4,055). Patient delay (median 5 days, range 0-189) was significantly shorter than HCS delay (median 49 days, range 4-4,025, P < 0.001). Diagnosis delay (median 58 days, range 3-4,015) was significantly longer than treatment delay (median 3 days, range 1-89, P < 0.001). Older age at diagnosis significantly lengthened patient delay (P = 0.044). Using alternative treatment was associated with significantly longer patient and total delay (P = 0.025, 0.024, respectively). Cancer type significantly influenced physician, diagnosis, treatment, HCS, and total delay (P = 0.001, P = 0.004, P < 0.001, P < 0.001, P < 0.001, respectively). Neurological tumors had the longest delays, whereas hematological tumors had the shortest. Sex, parents' education or income level, disease stage at diagnosis, health insurance status, distance from hospital, and first attended health-facility type did not significantly impact the length of any delay type.
  
  
  
  Healthcare providers need training to improve recognition of cancer symptoms and speed up subsequent diagnostic processes. Using alternative treatment increased patient and total delays. Community campaigns to encourage families to seek conventional cancer treatments are recommended.
authors: Department of Pediatrics, Nyi Ageng Serang District Hospital, Yogyakarta, Indonesia. dr.krisnahandayani@gmail.com.
authors: K
authors: K
authors: Handayani
authors: Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors: M N
authors: MN
authors: Sitaresmi
authors: Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors: E
authors: E
authors: Supriyadi
authors: Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors: P H
authors: PH
authors: Widjajanto
authors: Faculty of Medicine, Department of Pediatrics, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors: D
authors: D
authors: Susilawati
authors: Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors: F
authors: F
authors: Njuguna
authors: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors: P M
authors: PM
authors: van de Ven
authors: Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands.
authors: G J L
authors: GJ
authors: Kaspers
authors: Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands.
authors: S
authors: S
authors: Mostert
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D010353:Patient Education as Topic; D014187:Transportation of Patients
keywords: childhood cancer; delay; diagnosis; low-income country; treatment