Delays in access to paediatric oncology care: Perspectives from eight partner hospitals

Background. Most newly diagnosed children with cancer live in low-and middle-income countries (LMIC) where challenges in access to diagnosis and treatment cause low survival rates. Objective. To explore factors affecting delays in accessing paediatric oncology care at seven partner hospitals in LMIC (Malawi, Kenya, Tanzania and Kosovo) and one partner hospital in a high-income country (the Netherlands). Delays at community, primary/secondary and tertiary care levels are explored. Methods. Leaders of paediatric oncology un its from all eight partner hospitals were interviewed using self-administered structured questionnaires in July and August 2023. Results. Differences in diagnostics and treatment availability were observed between Dutch and LMIC settings. At the community level, all respondents acknowledged that parents’ inability to recognise cancer symptoms can lead to delays. Additional factors in LMICs included financial constraints, health beliefs and traditional medicine usage. At the primary/secondary care levels, all respondents acknowledged that misdiagnosis often delays referrals for children with suspected cancer. LMIC respondents also mentioned staff shortages and lack of health insurance. At the tertiary care level, only LMIC respondents reported delays, citing limited diagnostic or treatment modalities and a shortage of experienced staff. Across all settings, diagnosis delays were longer than treatment delays, with patient delays exceeding doctor delays, as noted by seven respondents. These factors contribute to low childhood cancer survival in LMICs. Conclusion. Delays at all levels hinder prompt access to paediatric oncology care in LMICs. A multi-factorial approach is needed to assure timely access and improve survival.