Delayed referral and treatment of paediatric cancer in Nigeria: Time to stop blaming the victim

Background: Caregiver delay in presentation has been cited as a major contributor to poor prognosis of paediatric cancers in low-middle income countries like Nigeria. This study explored the time duration between onset of symptoms and presentation to healthcare facilities, diagnosis, and referral for specialist care. Methods: Data were compiled from caregivers of newly registered children at a teaching hospital in Nigeria. Sociodemographic and clinical history of the child were taken. Type of cancer, date of diagnosis, centre where the diagnosis was made, treatment start date, and duration of symptoms until treatment were elicited from consenting caregivers and documented. Results: Acute lymphoblastic leukaemia was the most prevalent cancer type among the patients. The mean time from first symptom to presentation was 15 weeks and from presentation at any health care facility to specialist referral and diagnosis was 38 and 39 weeks, respectively. Time from diagnosis to treatment was a mean of 8 weeks (range: 1 to 27 weeks) Conclusion: Delayed presentation has become a commonly cited factor for poor cancer outcomes in Nigeria and may often inaccurately assign blame to the patient/caregivers. The results of this study point to delayed detection, delayed diagnosis and delayed referral for specialist care, as more accurate contributors to late-stage presentation and consequently worse outcomes of paediatric cancers in Nigeria. Strengthening of community and primary level healthcare professionals’ understanding of paediatric cancers, establishment of simple detection algorithms and national implementation of efficient referral protocols will potentially reduce delays in specialist attention and improve outcomes.