Disparities in the time and pilgrimage of families of children with cancer until arrival at a reference center for treatment in Brazil.

Abstract

This study assessed the timeline from the initial presentation of symptoms of major cancers to the arrival at and diagnosis by the reference center for pediatric oncology in Barretos, São Paulo, Brazil. The goal was to examine the flow of care within the healthcare system and identify disparities indicative of inequitable access to health services. We conducted a cross-sectional analysis of patient data over eight years. Quantitative variables were examined using median values, T-tests, Kruskal-Wallis tests, ANOVA, Bonferroni adjustments, and pairwise comparisons. Categorical variables were analyzed using the Chi-square test, with a significance threshold set at 5%. A total of 508 patients with malignant cancers were studied. Patients with hematologic cancers experienced the shortest median times from initial symptom perception (2 days), to the first healthcare visit (1 day), onward referral to a specialized center (30 days), and final diagnosis (35 days). This is in contrast to patients with central nervous system cancers (2, 3, 90, and 112.5 days respectively) and bone cancers (20, 7, 60, and 90 days respectively). Families from municipalities ranked lower on the GeoSES socioeconomic scale reported longer durations before recognizing initial symptoms (p-value = 0.037). Low initial diagnostic suspicion and systemic delays are primary obstacles that need addressing to enhance the diagnosis and treatment of pediatric cancer in Brazil's most populous state.