The role of routing in the diagnosis of acute leukemia in children: an observational retrospective non-randomized study
- Authors: Dolgopolov I.S.1,2, Rykov M.Y.3
-
Affiliations:
- Tver State Medical University, Tver
- Regional Children's Clinical Hospital, Tver
- Russian State Social University, Moscow
- Section: Original Study Articles
- Published: 26.08.2024
- URL: https://rjonco.com/1028-9984/article/view/629170
- DOI: https://doi.org/10.17816/onco629170
- ID: 629170
Cite item
Abstract
Introduction. Acute leukemia (AL) is the commonest malignancy of childhood. Early diagnosis of AL is difficult due to the non-specificity of primary symptoms, which are often hidden under the "masks" of other diseases.
Aim. Assess the delay in diagnosis depending on the areas of residence in the Tver region and area remoteness from the Tver Regional Clinical Children's Hospital.
Materials and methods. The analysis included 35 patients hospitalized in the Department of Oncology and hematology of the RCCH for the period from 2018 to 2023. The diagnoses were: ALL - 30 (86%), AML - 3 (9%), and AL of unspecified cell type (ALUCL) - 2 (5%) patients. The mean age was 61 months. Thrombocytopenia and anemia at the time of diagnosis were found in 76% and 78%, respectively. Leukocytosis > 20 x 109/L was observed in 58%, leukopenia < 3.5 x 109/L in 15% of patients. In 97% of cases blasts (2% to 95%) were detected in peripheral blood. In the city of Tver (group 1) and the Tver region (group 2), 16 (46%) and 19 (54%) patients were identified, respectively. The mean age of patients in group 1 is 28.6 months, and in group 2 - 72.3 months (p = 0.1).
Results. In group 1 and 2, ALL was diagnosed in 14 (88%) and 16 (84%), AML in 1 (6%) and 2 (11%) and ALUCL in 1 (6%) and 1 (5%) cases, p = 0.6, 0.7 and 0.95, respectively. Delay of diagnosis in the general group (n = 35) was observed < 2 weeks in 21 (60%) cases, 2-4 weeks - in 7 (20%), ≥4 - ≤ 8 weeks - in 4 (11%) and > 8 weeks - in 3 (9%) cases. Delayed diagnosis among patients living in the city of Tver and Tver region was observed < 2 weeks in 7 (44%) vs. 13 (68%) cases, 2-4 weeks - in 6 (38%) vs 3 (17%), ≥4 - ≤ 8 weeks - in 1 (6%) vs 1 (5%) and > 8 weeks - in 2 (12%) vs 2 (10%) cases, respectively (p = 0.37). There was no significant impact of the distance of the residence place from the level 3 children's hospital providing specialized care (RCCH) on the time of diagnosis.
Conclusion. The distance from the third-level hospital did not affect the period of diagnosis of AL in children.
Full Text
![Restricted Access](https://rjonco.com/lib/pkp/templates/images/icons/text_lock.png)
About the authors
Igor S. Dolgopolov
Tver State Medical University, Tver; Regional Children's Clinical Hospital, Tver
Email: irdolgopolov@gmail.com
ORCID iD: 0000-0001-9777-1220
SPIN-code: 4312-9786
MD, Dr. Sci. (Medicine), Assistant Professor
Russian Federation, TverMaxim Yu. Rykov
Russian State Social University, Moscow
Author for correspondence.
Email: wordex2006@rambler.ru
ORCID iD: 0000-0002-8398-7001
SPIN-code: 7652-0122
Dr. Sci. (Medicine), Associate Professor, Head of the Department of Pediatrics
Russian Federation, MoscowReferences
- Zwaan CM, Kolb EA, Reinhardt D, et al. Collaborative Efforts Driving Progress in Pediatric Acute Myeloid Leukemia. J Clin Oncol. 2015;33(27):2949–2962. doi: 10.1200/JCO.2015.62.8289
- Pui CH, Yang JJ, Hunger SP, et al. Childhood Acute Lymphoblastic Leukemia: Progress Through Collaboration. J Clin Oncol. 2015;33(27):2938–2948. doi: 10.1200/JCO.2014.59.1636
- Alexander TB, Wang L, Inaba H, et al. Decreased relapsed rate and treatment-related mortality contribute to improved outcomes for pediatric acute myeloid leukemia in successive clinical trials. Cancer. 2017;123(19):3791–3798. doi: 10.1002/cncr.30791
- Rotz SJ, Wei W, Thomas SM, Hanna R. Distance to treatment center is associated with survival in children and young adults with acute lymphoblastic leukemia. Cancer. 2020;126(24):5319–5327. doi: 10.1002/cncr.33175
- Brand NR, Qu LG, Chao A, Ilbawi AM. Delays and Barriers to Cancer Care in Low- and Middle-Income Countries: A Systematic Review. Oncologist. 2019;24(12):e1371–e1380. doi: 10.1634/theoncologist.2019-0057
- Dai Q, Liu R, Wang Y, et al. Longer Time Intervals From Symptom Onset to Diagnosis Affect the Overall Survival in Children With Acute Lymphoblastic Leukemia. Journal of Pediatric Hematology/Oncology. 2021;44:285–292. doi: 10.1097/MPH.0000000000002344
- Guide to cancer early diagnosis. Geneva: World Health Organization; 2017.
- Flytkjær Virgilsen L, Møller H, Vedsted P. Cancer diagnostic delays and travel distance to health services: A nationwide cohort study in Denmark. Cancer Epidemiol. 2019;59:115–122. doi: 10.1016/j.canep.2019.01.018
- Lins MM, Amorim M, Vilela P, et al. Delayed diagnosis of leukemia and association with morbid-mortality in children in Pernambuco, Brazil. J Pediatr Hematol Oncol. 2012;34(7):271–276. doi: 10.1097/MPH.0b013e3182580bea
- Begum M, Islam MJ, Akhtar MW, Karim S. Evaluation of delays in diagnosis and treatment of childhood malignancies in Bangladesh. South Asian J Cancer. 2016;5(4):192–193. doi: 10.4103/2278-330X.195343
- Fajardo-Gutiérrez A, Sandoval-Mex AM, Mejía-Aranguré JM, et al. Clinical and social factors that affect the time to diagnosis of Mexican children with cancer. Med Pediatr Oncol. 2002;39(1):25–31. doi: 10.1002/mpo.10100
- Baker JM, To T, Beyene J, et al. Influence of length of time to diagnosis and treatment on the survival of children with acute lymphoblastic leukemia: a population-based study. Leuk Res. 2014;38(2):204–209. doi: 10.1016/j.leukres.2013.11.014
- Hailu A, Mekasha A, Hailu D, et al. Impact of delay prior to treatment in Ethiopian children with acute lymphoblastic leukemia. Pediatric Health Med Ther. 2023;14:147–157. doi: 10.2147/PHMT.S406181
- Sergentanis T, Dessypris N, Kanavidis P, et al. Socioeconomic status, area remoteness, and survival from childhood leukemia: results from the Nationwide Registry for Childhood Hematological Malignancies in Greece. Eur J Cancer Prev. 2013;22(5):473–479. doi: 10.1097/CEJ.0b013e32835c7f69
- Gardie Y, Wassie M, Wodajo S, et al. Delay in diagnosis and associated factors among children with cancer admitted at pediatric oncology ward, University of Gondar comprehensive specialized hospital, Ethiopia: a retrospective cross-sectional study. BMC Cancer. 2023;23(1):469. doi: 10.1186/s12885-023-10873-8
- De Angelis C, Pacheco C, Lucchini G, et al. The experience in Nicaragua: childhood leukemia in low income countries—the main cause of late diagnosis may be “medical delay”. Int J Pediatr. 2012;2012. doi: 10.1155/2012/129707
- Tamefusa K, Ochi M, Ishida H, et al. Delayed diagnostic interval and survival outcomes in pediatric leukemia: A single-center, retrospective study. Eur J Haematol. 2023. doi: 10.1111/ejh.14162
- Charalampopoulou A, Petridou E, Spyridopoulos T, et al. An integrated evaluation of socioeconomic and clinical factors in the survival from childhood acute lymphoblastic leukaemia: a study in Greece. Eur J Cancer Prev. 2004;13(5):397–401. doi: 10.1097/00008469-200410000-00007
- Youlden DR, Baade PD, Valery PC, et al. Differentials in survival for childhood cancer in Australia by remoteness of residence and area disadvantage. Cancer epidemiology, biomarkers & prevention. 2011;20(8):1649–1656. doi: 10.1158/1055-9965.Epi-11-0432
- Janitz AE, Barber R, Campbell JE, et al. Measuring disparities in event-free survival among children with acute lymphoblastic leukemia in an academic institute in Oklahoma, 2005-2019. Cancer Epidemiol. 2022;81:102275. doi: 10.1016/j.canep.2022.102275
- Cancer Stat Facts: Childhood Leukemia [Internet]. National Cancer Institute. [cited 2024 Mar 10]. Available from: https://seer.cancer.gov/statfacts/html/childleuk.html
Supplementary files
![](/img/style/loading.gif)