Background: Timely diagnosis and initiation of therapy are critical determinants of survival in childhood cancer. In Pakistan, paediatric oncology services are highly centralised, and most children, particularly from rural and low-income households, experience prolonged delays with limited evidence on their cumulative magnitude and determinants. This study determined patient, diagnostic, treatment and health-system delays and identified predictors of prolonged total delay, defined as a cumulative interval exceeding 30 days from symptom onset to treatment initiation, among children with newly diagnosed malignancies.
Methods: An analytical cross-sectional study was conducted at the Paediatric Oncology Department, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from March to December 2025. Children aged 1–14 years with newly diagnosed malignancies who initiated definitive therapy were included. Data were collected through caregiver interviews, medical record review, and hospital administrative databases. Delay intervals were defined as patient delay (symptom onset to first healthcare contact), diagnostic delay (first contact to confirmed diagnosis), treatment delay (diagnosis to therapy initiation), health-system delay (first contact to treatment), and total delay (symptom onset to treatment). Multivariable logistic regression identified independent predictors of prolonged total delay (> 30 days).
Results: Seventy-one children were analysed (median age 5 years; 67.6% male; 71.8% rural). Median total delay was 36 days (IQR 49), with 57.7% experiencing prolonged delay. Patient delay exceeded 14 days in 46.5%, while health-system delay affected 61.9%. Diagnostic delays beyond 21 days occurred in 25.4% and treatment delays were comparatively limited (18.3%). Prolonged delay was independently associated with rural residence (adjusted OR 2.42, 95% CI 1.16–5.03), low household income (< 50,000 PKR; aOR 3.09, 95% CI 1.42–6.72), first healthcare contact outside a tertiary centre (aOR 3.96, 95% CI 1.82–8.63), lack of parental education, absence of caregiver awareness of childhood cancer (aOR 2.85, 95% CI 1.29–6.31) and diagnosis of a solid tumour (aOR 2.67, 95% CI 1.29–5.53).
Conclusion: Delays in childhood cancer care in Pakistan arise from socioeconomic vulnerability, geographic inequity and fragmented health-system pathways at this single-centre site. These delays directly correlate with advanced-stage presentation and reduced survival. Decentralised diagnostics, standardised referral systems, primary healthcare training, social support and community awareness are urgently needed to reduce delays and enhance survival in resource-constrained settings.
