Background
Although relatively rare, childhood cancer (CC) represents a major public health challenge due to its high mortality at early ages and its profound social and family impact. In Colombia, significant gaps persist in the early detection of CC, particularly at the primary health care (PHC) level, where initial symptoms are often nonspecific and easily confused with common childhood conditions. Despite the implementation of global and national strategies—such as the Integrated Management of Childhood Illness (IMCI), clinical practice guidelines, the Integrated Health Care Pathway, and the WHO Global Initiative for Childhood Cancer (CureAll)—diagnostic delays remain frequent, largely related to limited knowledge among health professionals and structural barriers within the health system.
Objective
To assess the knowledge and perceptions of primary health care professionals regarding the early detection of childhood cancer in outpatient services of public and private low-complexity health institutions in five prioritized Colombian cities.
Methods
An observational cross-sectional study with a mixed-methods approach was conducted. A structured knowledge questionnaire on early detection of childhood cancer was administered to 141 health professionals, including nurses, general practitioners, family physicians, and pediatricians, from five Colombian cities with the highest childhood cancer mortality rates (Barranquilla, Florencia, Neiva, Valledupar, and Villavicencio). In addition, focus groups with the same professional profiles were conducted to explore perceptions, barriers, and facilitators related to early detection. Multivariate analysis was performed to identify factors associated with questionnaire performance, and qualitative thematic analysis was used to identify barriers and facilitators to early detection of childhood cancer in primary care.
Results
A total of 54.6% of participants were general practitioners, 21.2% nursing professionals, 19.1% pediatricians, and 5% family physicians. Variability in knowledge levels regarding childhood cancer was observed across cities and professional groups; overall, 50% of participants demonstrated an adequate level of knowledge. Nursing professionals obtained the lowest mean scores, while Valledupar showed the lowest overall performance. From the qualitative component, several barriers to early detection were identified, including insufficient infrastructure, shortages of specialized human resources, fragmentation of the health care system, administrative delays, and geographic barriers to access. Gaps in undergraduate training in pediatric oncology and underestimation of warning signs at the primary care level were also highlighted. Identified facilitators included support networks, health promotion and prevention activities, and training initiatives led by institutions such as the National Cancer Institute and local health authorities.
Conclusions / Implications

Although an overall acceptable level of knowledge on childhood cancer was observed among primary care professionals, substantial gaps persist that hinder early detection, particularly in settings with limited health system capacity. Strengthening health workforce training, consolidating sustainable educational strategies, and improving health system coordination are essential actions to translate evidence into effective interventions and reduce inequities in childhood cancer care in Colombia and other middle-income countries.