IARC 60th Anniversary - 19-21 May 2026
Session : Childhood Cancer Research in Action: Bridging Population Science and Discovery
DIAGNOSTIC INTERVALS AND PATHWAYS TO CHILDHOOD CANCER DIAGNOSES IN CAMEROON & KENYA
CHELVA M. 1, GASCON B. 1, PONDY A. 2, MBAH G. 3, FONGANG L. 4, GITHANGA J. 5, NZAMU I. 6, NDUNGU M. 7, DIXON J. 3, MARTINIUK A. 8,9, MUNKI E. 4, GAMENI D. 4, MWANGO L. 7, BARWICK M. 1,10,11,12, GUPTA S. 11,13, DENBURG A. 11,13
1 Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada; 2 Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon; 3 World Child Cancer, Surrey, United Kingdom; 4 EWSS Project, Yaoundé, Cameroon; 5 Department of Human Pathology, University of Nairobi, Nairobi, Kenya; 6 Pediatric Hematology & Oncology Unit, Kenyatta National Hospital, Nairobi, Kenya; 7 EWSS Project, Nairobi, Kenya; 8 International Centre for Future Health Systems, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia; 9 Daffodil Centre, University of Sydney, Sydney, Australia; 10 Department of Psychiatry, Division of Child Psychiatry, Temerty Faculty of Medicine, Toronto, Canada; 11 Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, Toronto, Canada; 12 School of Behavioural Health Sciences, Dalla Lana School of Public Health, Toronto, Canada; 13 Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
Background: Delayed diagnosis contributes to poor outcomes for children with cancer in Cameroon and Kenya. Data on diagnostic intervals, referral pathways, and factors influencing diagnosis are limited. Understanding these patterns can reveal inequities and guide interventions to improve earlier detection in low- and middle-income countries.
Objectives: 1) To describe and compare medical, sociodemographic, and diagnostic pathways for children with cancer in Kenya and Cameroon; 2) To identify factors associated with different types of diagnostic intervals.
Methods: This observational study used retrospective chart audit data from tertiary pediatric cancer centres in Cameroon (Chantal Biya Mother and Child Centre; Mbingo Baptist Hospital) and Kenya (Kenyatta National Hospital), collected between June 2022 and August 2025 as part of an early warning signs and symptoms implementation program. Referral (RI), diagnostic (DI), and total diagnostic intervals (TDI) were calculated. Associations with first healthcare contact and cancer type (hematological vs. solid tumours) were assessed using Mann-Whitney U and Kruskal-Wallis tests. Analyses were performed in SPSS.
Results: 1,489 children with cancer were included (Cameroon: n = 712; Kenya: n = 777). In Cameroon, Burkitt lymphoma (39.0%), Wilms tumour (8.7%), and ALL (7.4%) predominated. In Kenya, ALL (25.7%) and retinoblastoma (24.8%) were the most common. Children in Cameroon were older (median 10 vs. 6 years) and more often male (60.4% vs. 54.1%). Insurance coverage was lower in Cameroon (4.8%) than in Kenya (84.3%), and travel times ≥4 hours were more common in Cameroon (59.7% vs. 35.8%). Presenting symptoms included mass/swelling (Cameroon 54.5%; Kenya 26.0%), fever (44.7%; 20.6%), and abdominal distension (34.4%; 5.3%). First visits were usually at primary-level facilities. Hematologic malignancies accessed care earlier; solid tumours, particularly in Cameroon, followed heterogeneous pathways. Retinoblastoma in Kenya often prompted direct secondary/tertiary presentation. In Cameroon, the median RI, DI, and TDI were 39 (IQR: 14–87), 46 (IQR: 19–91), and 61 (IQR: 25–111), respectively. In Kenya, median RI and DI were 12 (IQR: 2–62) and 13 (IQR: 1–51), respectively, while median TDI was higher at 71 (IQR: 26–156). In Cameroon, diagnostic pathway intervals varied by cancer type (RI, DI, TDI: p < 0.001), with solid tumours showing a median TDI that was 13 days longer than hematological cancers. In Kenya, these differences were less pronounced (RI: p = 0.04; DI: p = 0.03; TDI: p = 0.01). In Cameroon, primary-level or informal care was linked to longer RI, DI, and TDI (p < 0.001). In Kenya, primary-level presentation was associated with longer RI (p = 0.03), DI (p = 0.02), and TDI (p = 0.01). In Cameroon, ALL was associated with having more than two healthcare contacts prior to diagnosis (p = 0.010); no stable associations were seen in Kenya (p > 0.05).
Conclusions/Implications: Diagnostic intervals for children with cancer in Cameroon and Kenya are prolonged and more variable than those reported in many high-income settings, highlighting the potential for targeted health system interventions to improve these delays. Further analysis of additional health system factors will help clarify contextual barriers and inform tailored strategies.