title: [Care pathways before diagnosis in children and adolescents with malignancies].
abstract: OBJECTIVE
  to describe medical care pathways between first symptoms and first oncologic consultation in children and adolescents with solid cancers in order to analyze a possible relationship between delayed diagnosis and its potential consequences.
  
  
  METHODS
  Retrospective study on patients aged less than 25 years at first consultation in the oncology department of pediatric, adolescent and young adult in Institut Curie during one year. Were collected data on cancer characteristics, components of care pathways, and sociodemographic parents' characteristics.
  
  
  RESULTS
  Hundred and six patients were selected, with median age of 6 years. Most represented tumor was low-grade cerebral tumor (17.0%). Pain was the most frequent type of disorder observed as first sign (34.3% of patients). First signs were unspecific in only 27.6% of cases. Most patients were first seen by a general practitioner (29.3%). Median total time to diagnosis was one month [ranges: 0-64]. Median number of consultations before referral to oncology expert was 2 [0-7]. Retrospective analysis found a possible delayed diagnosis in 44.3% of patients, with potential vital and functional risks estimated respectively at 14.1 and 20.7% of overall population. Time to diagnosis was shorter if father was of foreign nationality vs. French (34 days vs. 72 days, P<0.05), and longer if parents were separated (74.5 days vs. 42.5 days, P<0.03).
  
  
  CONCLUSIONS
  Overall time to diagnosis is quite fast, even if first signs of pediatric cancers are very polymorphic. Some medical and sociodemographic factors could influence characteristics of care pathways.
authors.affiliation: AP-HP, hôpital Ambroise-Paré, service de pédiatrie générale, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tatencloux
authors.affiliation: Institut Curie, département de biostatistiques, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Mosseri
authors.affiliation: AP-HP, hôpital Ambroise-Paré, service de pédiatrie générale, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
authors.forename: Solesne
authors.initials: S
authors.lastname: Papillard-Maréchal
authors.affiliation: AP-HP, hôpital Louis-Mourier, service de pédiatrie, 278, rue des Renouillers, 92701 Colombes, France.
authors.forename: Bettina
authors.initials: B
authors.lastname: Mesples
authors.affiliation: Centre hospitalier intercommunal de Poissy-Saint-Germain en Laye, service de pédiatrie, 10, rue Champ-Gaillard, 78300 Poissy, France.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Pellegrino
authors.affiliation: Centre hospitalier Robert-Ballanger, service de pédiatrie, boulevard Robert-Ballanger, 93600 Aulnay-sous-Bois, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Belloy
authors.affiliation: Institut Curie, département de pédiatrie, adolescents, jeunes adultes, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: Irene
authors.initials: I
authors.lastname: Jimènez
authors.affiliation: Institut Curie, département de biostatistiques, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Algret
authors.affiliation: Institut Curie, département de pédiatrie, adolescents, jeunes adultes, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Levy
authors.affiliation: Institut Curie, département de pédiatrie, adolescents, jeunes adultes, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Michon
authors.affiliation: Institut Curie, département de pédiatrie, adolescents, jeunes adultes, 26, rue d'Ulm, 75005 Paris, France. Electronic address: daniel.orbach@curie.fr.
authors.forename: Daniel
authors.initials: D
authors.lastname: Orbach
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D002173:Cancer Care Facilities; D000072716:Cancer Pain / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000009:adverse effects* / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D005602:France; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008637:Mesenchymoma / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000453:epidemiology; D012959:Socioeconomic Factors; D063189:Symptom Assessment; D055815:Young Adult
keywords: Cancer; Cancers pédiatriques; Care pathways; Children; Diagnosis delay; Délai diagnostique; Parcours de soins