Epidemiological Situation of Pediatric and Adolescent Cancer in a Referral Hospital in Peru: Public Health Implications

Epidemiological Situation of Pediatric and Adolescent Cancer in a Referral Hospital in Peru: Public Health Implications | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 17 June 2025 V1 Latest version Share on Epidemiological Situation of Pediatric and Adolescent Cancer in a Referral Hospital in Peru: Public Health Implications Authors : Jesus Dominguez-Rojas 0000-0001-6141-6622 [email protected] , Jenny Villalobos Alva , and Lily Jannete Saldaña Gallo Authors Info & Affiliations https://doi.org/10.22541/au.175016307.79749243/v1 275 views 119 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Pediatric cancer remains a significant cause of morbidity and mortality in low- and middle-income countries. In Peru, structural barriers limit timely diagnosis, comprehensive treatment, and proper epidemiological registration. Methods: A retrospective, observational, and descriptive study based on the 2024 institutional cancer registry from the Instituto Nacional de Salud del Niño (INSN) using the national epidemiological surveillance guideline (NTS No. 199-MINSA/CDC-2023). Results: 175 cases of pediatric cancer were registered, of which 121 (69.1%) were malignant. Most patients came from Lima (56.2%). The most affected age group was 5–9 years (34.7%). The average diagnostic delay was 69 days. Histological confirmation was achieved in 97.7% of cases. Ten children died (8%), and 87.3% were referred to INEN for treatment. Conclusions: Peru faces critical delays in childhood cancer diagnosis and inequities in access to care. National reforms are needed to decentralize services, improve early detection, and ensure integrated oncologic treatment. Epidemiological Situation of Pediatric and Adolescent Cancer in a Referral Hospital in Peru: Public Health Implications Jesus Domínguez-Rojas PhD MD1, Jenny Villalobos Alva MD2, Lily Jannete Saldaña Gallo PhD MD3 1. Departamento de Emergencias y Áreas Críticas. Instituto Nacional de Salud del Niño- Breña. Pediatra Intensivista oncólogo, Lima- Perú 2. Departamento de Especialidades Quirúrgicas. Instituto Nacional de Salud del Niño- Breña. Cirujana oncóloga, Lima- Perú 3. Departamento de Especialidades Quirúrgicas. Instituto Nacional de Salud del Niño- Breña. Cirujana oncóloga, Lima- Perú Corresponding author: Jesus Dominguez-Rojas, email: [email protected] , Address: Fray Angelico 238 San Borja, Peru. Autor Abstract Background: Pediatric cancer remains a significant cause of morbidity and mortality in low- and middle-income countries. In Peru, structural barriers limit timely diagnosis, comprehensive treatment, and proper epidemiological registration. Methods: A retrospective, observational, and descriptive study based on the 2024 institutional cancer registry from the Instituto Nacional de Salud del Niño (INSN) using the national epidemiological surveillance guideline (NTS No. 199-MINSA/CDC-2023). Results: 175 cases of pediatric cancer were registered, of which 121 (69.1%) were malignant. Most patients came from Lima (56.2%). The most affected age group was 5–9 years (34.7%). The average diagnostic delay was 69 days. Histological confirmation was achieved in 97.7% of cases. Ten children died (8%), and 87.3% were referred to INEN for treatment. Conclusions: Peru faces critical delays in childhood cancer diagnosis and inequities in access to care. National reforms are needed to decentralize services, improve early detection, and ensure integrated oncologic treatment. Keywords: Pediatric oncology, childhood cancer, epidemiology, health systems, Peru 1. Introduction Childhood cancer represents 0.5–3% of global cancer cases, with an estimated incidence of 50–200 per million children annually [1]. Around 400,000 children and adolescents aged 0–19 are diagnosed each year [2]. In Latin America and the Caribbean, 30,000 cases occur annually, and 10,000 children die [3]. Survival is highly unequal: middle-income nations [4,5]. In Peru, cancer is the second leading cause of death in children aged 5–14 [6]. National incidence is estimated at 18.3 per 100,000, with a mortality of 7.5 per 100,000 [6]. The most common cancers are leukemias, CNS tumors, and lymphomas [7]. This trend reflects a dual burden of disease during the epidemiological transition. 2. Methods A retrospective descriptive study was conducted at INSN using the NotiWeb surveillance platform, patient records, and specialized service registries (onco-hematology, neurosurgery, pediatric surgery), in line with NTS No. 199-MINSA/CDC-2023 [8]. Inclusion criteria: confirmed malignant neoplasms in patients cases. Variables included age, sex, origin, tumor type, specialty, diagnostic time, referrals, and patient status. Ethical handling followed institutional surveillance protocols. 3. Results Table 1. Distribution of pediatric cancer cases by age group and sex, INSN 2024 1–4 years 38 (31.4%) 20 18 5–9 years 42 (34.7%) 21 21 10–14 years 34 (28.1%) 17 17 15–17 years 7 (5.8%) 3 4 Interpretation: The highest proportion of cancer cases was observed in children aged 5–9 years, followed by 1–4 years, aligning with global trends in pediatric oncology. Gender distribution was nearly equal in all groups, with no significant male or female predominance. Table 2. Average diagnostic time by tumor type, INSN 2024 CNS tumors 57 No Leukemias 30 Yes Renal tumors 77 No Liver tumors 46 No Soft tissue sarcomas 58 No Interpretation: Diagnostic delays were most pronounced in renal, soft tissue, and CNS tumors, all of which surpassed the recommended 30-day threshold. Only leukemia cases met the national diagnostic timing standard, reflecting better recognition and diagnostic pathways for hematologic malignancies. Table 3. Key epidemiological indicators, INSN 2024 Histological confirmation 97.7% ≥90% Cancer-related pediatric mortality 8% — Referral to INEN 87.3% — Mean time to diagnosis 69 days <30 days Surgical intervention (onc/neurosurgery) 90.4% — Interpretation: Most epidemiological indicators reflect strengths in diagnostic confirmation and surgical access, but the 69-day average diagnostic delay is a critical shortcoming. The high referral rate to (Instituto Nacional de Enfermedades Neoplasicas) INEN highlights the limited oncology treatment infrastructure within the INSN and the need for decentralization. Most cases were malignant (69.1%), and 52.1% were female. Delays in diagnosis were most prominent for renal and CNS tumors. Referrals to INEN were frequent due to limited in-hospital treatment capacity. 4. Discussion The Peruvian pattern of pediatric cancer mirrors trends in Latin America, with high leukemia and CNS tumor incidence [7,9]. Diagnostic delay—averaging 69 days—far exceeds the national goal and impairs outcomes [4,10]. Geographic centralization of care in Lima creates barriers for children from rural areas, exacerbating inequity [11]. The WHO-St. Jude Global Initiative for Childhood Cancer aims for 60% survival by 2030. Peru must act to meet this goal by strengthening regional capacity, training personnel, and standardizing care [12,13]. System improvements should include interoperable registries, national data monitoring, and financial protection mechanisms for families [14,15]. 5. Conclusions Peru’s health system faces structural challenges in delivering timely and comprehensive pediatric cancer care. Epidemiological surveillance has improved visibility, but reforms are essential to guarantee equity and survival. 6. Recommendations 1. National electronic health record integration. 2. Maximum waiting time benchmarks for rural referrals. 3. Regional pediatric oncology centers with specialized teams. 4. Real-time national childhood cancer registry. 5. Dedicated public funding for childhood cancer. Ethics Approval and Consent to Participate This study was conducted under institutional epidemiological surveillance procedures and did not require informed consent. Funding This research received no specific grant from any funding agency. Conflicts of Interest The authors declare no conflict of interest. References 1. Steliarova-Foucher E, Colombet M, Ries LAG, Moreno F, Dolya A, Bray F, et al. International incidence of childhood cancer, 2001–10: a population-based registry study. Lancet Oncol. 2017;18(6):719–731. 2. World Health Organization. Childhood cancer [Internet]. Geneva: WHO; 2023 [cited 2025 May 15]. Available from: https://www.who.int/cancer/childhood-cancer/en/ 3. Pan American Health Organization. Diagnóstico precoz del cáncer infantil [Internet]. Washington, DC: PAHO; 2022 [cited 2025 May 15]. Available from: https://www.paho.org/es/campanas/diagnostico-precoz-cancer-infantil 4. Howard SC, Metzger ML, Wilimas JA, Quintana Y, Pui CH, Robison LL, et al. Childhood cancer: progress and challenges in the global context. Lancet Oncol. 2008;9(10):101–108. 5. Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro RC, Harif M, Li CK, et al. Paediatric cancer in low-income and middle-income countries. Lancet Oncol. 2013;14(3):e104–e116. 6. Chávez-Paredes SL, Vásquez L, Zúñiga-Venegas L, Lecca ME. El cáncer infantil en el Perú. Diagnóstico. 2024;63(2):103–109. 7. Maradiegue-Chirinos EM, Ríos Dávila MA, Gómez Ríos A, Vásquez-Medina J, Salas Palacios R. El cáncer infantil en el Perú. Diagnóstico. 2024;63(2):110–117. 8. Ministerio de Salud del Perú. Norma Técnica de Salud N°199-MINSA/CDC-2023: Vigilancia Epidemiológica de Cáncer en General y Cáncer en Niños y Adolescentes. Lima: MINSA; 2023. 9. International Agency for Research on Cancer. Peru - Global Cancer Observatory [Internet]. Lyon: IARC; 2022 [cited 2025 May 15]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/604-peru-fact-sheets.pdf 10. Vásquez L, Oscanoa M, Oscanoa T, Paredes-Sánchez A, Málaga G. Diagnostic delay in childhood cancer in a developing country. Pediatr Hematol Oncol. 2016;33(3):174–183. 11. Pérez-Cuevas R, Doubova SV, Mejía-Arango S, Arreola-Ornelas H, Hernández-Ávila M. Improving access to care for children with cancer in Latin America. Lancet Oncol. 2017;18(7):1073–1075. 12. Ribeiro RC, Pui CH. Saving the children—improving childhood cancer treatment in developing countries. N Engl J Med. 2005;352(16):2158–2160. 13. Arora RS, Eden TOB, Kapoor G. Epidemiology of childhood cancer in India. Indian J Cancer. 2009;46(4):264–273. 14. Atun R, Jaffray DA, Barton MB, Bray F, Baumann M, Vikram B, et al. Expanding global access to radiotherapy. Lancet Oncol. 2015;16(10):1153–1186. 15. Ward ZJ, Yeh JM, Bhakta N, Frazier AL, Atun R. Estimating the total incidence of global childhood cancer: a simulation-based analysis. Lancet Oncol. 2019;20(4):483–493. Information & Authors Information Version history V1 Version 1 17 June 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords epidemiology infant leukemia pediatric oncology Authors Affiliations Jesus Dominguez-Rojas 0000-0001-6141-6622 [email protected] Instituto Nacional de Salud del Nino View all articles by this author Jenny Villalobos Alva Instituto Nacional de Salud del Nino View all articles by this author Lily Jannete Saldaña Gallo Instituto Nacional de Salud del Nino View all articles by this author Metrics & Citations Metrics Article Usage 275 views 119 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Jesus Dominguez-Rojas, Jenny Villalobos Alva, Lily Jannete Saldaña Gallo. Epidemiological Situation of Pediatric and Adolescent Cancer in a Referral Hospital in Peru: Public Health Implications. Authorea . 17 June 2025. DOI: https://doi.org/10.22541/au.175016307.79749243/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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