BACKGROUND: Insufficient awareness of early warning signs of childhood cancer (EWSS) among frontline health care professionals leads to delayed diagnosis and late referrals in resource-limited settings like Pakistan. Unfortunately, childhood cancer cannot be prevented like adult cancers, therefore, essential strategies are imperative for early diagnosis and timely referral. Primary and secondary health care professionals’ effective trainings regarding EWSS can play a crucial role. However, there is limited evidence and significant gaps regarding knowledge of healthcare providers (HCPs) for childhood cancer (CC) early diagnosis in Pakistan.
Objective of this study to assess the level of knowledge, attitudes, and practices on Childhood Cancer among primary and secondary HCPs to combat the challenge of delayed diagnosis and to improve survival.
METHODS: A cross-sectional questionnaire was administered to three sets of HCPs of primary and secondary HCPs of pilot project district Kasur, tertiary care hospitals of Lahore, HCPs of five divisional public sector medical schools of Punjab in 2023, 2024 and 2025.
RESULTS: A total number of Two hundred and eighty-three health care professionals, including (91% LHS/LHV/CHIs/Nurses) and (8.5 % Pediatric doctors), participated in the surveys from Kasur (Cohort 1), 318 from Lahore tertiary care centers (Cohort2) and 99 from Medical Schools across Punjab (Cohort3). There were 97.2 % females in first,56% in second and 64% females in 3rd cohort; 48.4 %, 23%, and 24% were older than 35 years in cohort 1, 2 and 3. Overall knowledge regarding key warning signs of CC was moderate, with better recognition of persistent fever, unexplained weight loss with 98.9%, demonstrated sufficient knowledge of early warning signs and symptoms (EWSS) of CC. While less common presentations like leukocoria identification was comparatively lower 78.4 %, 50% and 64% respectively. 88.7 %, 60% and 61% incorrectly indicated that CC is preventable and 74.2 % assumed that any child is at risk for CC. Attitudinal responses signified strongly on the importance of early diagnosis and timely referral. 96.1 % responded positively for the initiation of EWSS of Childhood Cancer programs, with 98% confident to learn and teach others regarding EWSS of CC. In three cohorts, 71.7%, 45% and 32% reported that CC baseline tests and equipment is a challenge to conduct. Practice related findings revealed that CC reported they suspected (24.7%, 49% and 86%) and referred (21.9%,39%72%) childhood cancer cases respectively in three cohorts
CONCLUSION: Overall knowledge was satisfactory towards early detection of CC. This study highlights significant gaps and strengths in knowledge, attitudes and practices related to CC among primary, secondary and tertiary care HCPs in Kasur, Lahore and across Punjab Pakistan. There remain areas of educational training needs for EWSS of CC. Attitudes towards early diagnosis linked with better survival were quite positive but to translate them into sustainable practices, early diagnosis training programs should be prioritized not only for tertiary care but also promoted as crucial for primary and secondary HCPs to strengthen their role of frontline health care givers in the early diagnosis and timely referral of Childhood Cancer patients in Pakistan.