Background: Timely diagnosis of childhood cancer is fundamental to achieve the target set by WHO CureAll global initiative by 2030 to significantly improve cancer survival up to 60%, globally. However, despite substantial health and economic rationale (“best buy”) for investment in childhood cancer, major knowledge and implementation gaps persist at the local level, largely due to a lack of robust local data to guide decision-making and strategic investments in childhood cancer care.

Objectives: We aimed to quantify the intervals in childhood cancer care pathway, evaluate the cost burden, survival, and health system readiness to deliver comprehensive quality care services.

Methods: Childhood cancer care study in Nepal (DECAN-CHILD) study started in 2022 at the largest comprehensive oncology centre (B.P. Koirala Memorial Cancer Hospital) in Nepal. The initial cohort consisted of 168 consecutive childhood cancer patients newly registered at the hospital. From the beginning of 2026, the study is expanded to four major tertiary hospitals in the Capital city, Kathmandu, and expected to cover approximately 80% of all identified childhood cancer cases in the country. The detailed cost burden and health system capacity will be assessed in selected number of secondary and tertiary hospitals in addition to four primary hospitals. Baseline results of study conducted in BPKMCH hospital are presented here.  Sociodemographic status and various time-points (symptom recognition, health facility visits, diagnosis, and treatment initiation) data were collected through face-to-face interview of patients’ caregiver using a semi-structured questionnaire. Additionally, hospital medical records were used to verify various time-points and to collect clinical and pathological data depending upon the cancer types. The association between socioeconomic variables and access delay, diagnostic delay, and treatment delay were explored.

Results: Overall, 79% (133/168) waited >30 days to diagnosis and 70% waited >60 days to treatment. The median total interval from symptom onset to treatment was 91 days (IQR 52–152), reaching 119 days (IQR 68–319) for lymphoma and 110 days (IQR 63–161) for solid tumours. Access delays (from symptom recognition to first visit to health facility) were significantly higher among children with low parental education (mothers adj. IRR 2.04, 95% CI 1.91–2.30; fathers adj. IRR 1.26, 1.15–1.39) and with low socioeconomic (‘Janajati’) ethnicity (adj. IRR 1.48, 1.38–1.59). Patients who visited than 3 health facilities had significant delay in diagnosis (adj. IRR=2.54, 95% CI 2.45-2.65).

Conclusion: We highlighted unacceptably longer delays from identification of symptom to accessing diagnostic and treatment services in patients diagnosed with childhood cancer in Nepal. The study results can be utilized to inform professional and public health strategies and health policy to accelerate diagnosis. Future results on cost burden and health system capacity will help inform national childhood cancer control plan forecasting, priority setting, and resource allocation, and in doing so, improve childhood outcomes in Nepal and in similar settings and addresses the goal set by WHO Global Initiative on Childhood Cancer.

Pre-diagnostic, diagnostic, and treatment intervals in patients diagnosed with childhood cancer in Nepal