DISP-40. ARE DEMOGRAPHIC FACTORS CONTRIBUTING TO THE DELAYED DIAGNOSIS OF PEDIATRIC CNS TUMORS IN LMICS? THE INDONESIAN NATIONAL HOSPITAL PERSPECTIVE

Abstract BACKGROUND AND AIMS Pediatric central nervous system (CNS) tumors pose a significant health burden in low- and middle-income countries (LMICs), including Indonesia. Indonesia comprises 38 provinces spread across more than 17,000 islands, with the main islands being Sumatra, Java, Bali & Nusa Tenggara, Kalimantan, Maluku, Sulawesi, and Papua. Each province boasts its distinct culture, geography, and demographics, contributing to Indonesia’s diverse national identity. Delayed diagnosis of these tumors is a critical issue, impacting treatment outcomes. This study aims to investigate the demographic factors contributing to the delayed diagnosis of pediatric central nervous system (CNS) tumors in low- and middle-income countries (LMICs), focusing on the perspective of the Indonesian National Hospital. METHODS A retrospective, observational, longitudinal study was conducted at Cipto Mangunkusumo National General Hospital, utilizing patients’ demographic and diagnosis profiles, from January 2022 to December 2023. RESULTS A study involving 101 patients, predominantly girls (54.5%), showed a median age of 8 years (IQR 4-12). The median intervals from symptom onset to first medical consultation, diagnosis, and treatment were two weeks (IQR: 0-11), eight weeks (IQR: 4-26), and 13 weeks (IQR: 6-31), respectively. While age and sex did not correlate significantly with delays, the study found that the delay in diagnosis was not primarily due to geographical distance (p = 0.699) but instead to referrals from local hospitals that were unable to handle such cases (p = 0.047). There was a strong positive correlation between delays in seeking medical consultation and delays in diagnosis and treatment (p <.001). Uncommon symptoms like puberty abnormalities, macrocephaly, and proptosis often lead to prolonged delays in seeking medical attention and diagnosis. CONCLUSIONS Delayed diagnosis of pediatric CNS tumors in LMICs, such as Indonesia, remains a critical issue with significant impacts on treatment outcomes. Addressing these challenges in Indonesia could significantly reduce diagnosis-treatment delay time and improve outcomes for children with CNStumors in LMICs.