Diagnostic delay and initial healthcare-seeking pathways in childhood cancer: A cross-sectional study at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh

Abstract

Background: In Bangladesh approximate 9000 cases of childhood cancer are diagnosed each year; however, however, only 5% of them receive treatment. Over 80% of children with cancer are not diagnosed or appropriately treated in Bangladesh, highlighting the need to investigate diagnostic delays and health-seeking pathways.

Objectives: To identify the factors associated with diagnostic delay among childhood cancer patients in Bangladesh and to assess how caregiver’s initial healthcare-seeking pathways influence the time to diagnosis.

Methods: A cross-sectional quantitative study was conducted from January, 2026 to June, 2026. Face-to-face interviews were done with the primary caregivers of childhood cancer patients admitted at the in-patient department of the pediatric hematology and oncology, National Institute of Cancer Research and Hospital, using Kobo Toolbox and 152 data were collected. Non-parametric tests (Mann-Whitney U and Kruskal-Wallis tests) were used to test and find association between independent variables and outcome variable (total interval) while the data was summarized by descriptive statistics. Data analysis was performed using STATA version 17 software, and p-values <0.05 were considered statistically significant. Institutional Review Board of BRAC James P Grant School of Public Health, BRAC University (IRB Ref: MPH-2025-009) approved the study and written informed consent was obtained from all participants.

Results: The median total interval (time from symptom recognition to confirmed diagnosis) was 91 days (IQR: 52.5-188.5 days). The diagnostic interval was the major component of delay (median: 82.5 days, IQR: 44.2-149.7), while the patient interval was short (median: 2 days, IQR:1-7 days). Significant difference in diagnostic delay was observed across cancer types, with longer intervals for retinoblastoma (234 days), CNS tumors (145 days) and bone tumors (121 days), compared to renal tumors (35 days) and leukemia (65 days). There was a significant relationship between the total interval and family income, with the lowest income group having a median interval of 105 days and the highest income group having a median interval of 23 days (p = 0.030). Longer intervals were significantly associated prolonged time interval between first and subsequent healthcare visits (p = 0.0001), multiple healthcare facility visits (p= 0.002), and higher pre-diagnostic expenditure (p=0.002) Higher proportions of delay was associated with care pathways, where informal sector providers were the first point of contact.

Conclusions: Diagnostic delay in childhood cancer patients is primarily influenced by health-system barriers, alongside socio-demographic and clinical factors. The findings suggest the need to strengthen referral system across care continuum that will allow early recognition of symptoms and timely diagnosis of cancer. Integrating referral support, reducing financial obstacles, training of frontline healthcare providers, decentralizing pediatric oncology services may help to reduce the diagnostic delay.