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International Journal of Pediatrics
Volume 2012, Article ID 129707, 5 pages
Clinical Study

The Experience in Nicaragua: Childhood Leukemia in Low Income Countries—The Main Cause of Late Diagnosis May Be “Medical Delay”

1Pediatric Department, San Gerardo Hospital and University of Milano Bicocca, via Pergolesi 33, 20900 Monza (MB), Italy
2Pediatric Hemato-Oncology Department, Manuel de Jesus Rivera “La Mascota” Hospital, Managua, Nicaragua
3Pediatric Department, “Ospedali Riuniti”, Largo Barozzi 1, 24128 Bergamo (BG), Italy

Received 4 September 2011; Revised 2 November 2011; Accepted 11 November 2011

Academic Editor: Emmanuel Katsanis

Copyright © 2012 C. De Angelis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. The event-free survival for pediatric leukemia in low-income Countries is much lower than in high-income countries. Late diagnosis, which is regarded as a contributing factor, may be due to “parental” or “medical” delay. Procedures. The present study analyses determinants of lag time from first symptoms to diagnosis of leukemia, comparing pediatric (0–16 years old) patients in two referral centers, one in Nicaragua and one in Italy. An observational retrospective study was conducted to assess factors influencing the time to diagnosis. Results. 81 charts of children diagnosed with acute myeloid leukemia or lymphoblastic leukemia were analyzed from each centre. Median lag time to diagnosis was higher in Nicaragua than in Italy (29 versus 14 days, ) and it was mainly due to “physician delay” (16.5 versus 7 days, ), whereas “patient delay” from symptoms to first medical assessment was similar in the two centers (7 versus 5 days, ). Moreover, median lag time from symptoms to diagnosis was decreased in Nicaraguan districts were a specific training program upon childhood oncological diseases was carried out (20.5 versus 40 days, ). Conclusions. Our study shows that delay in diagnosis of childhood leukemia is mainly associated with “physician delay” and it may be overcome by programs of continuous medical education.