Lymphomas are a diverse group of hematopoietic neoplasms resulting from the malignant transformation of lymphoid cells and their precursors.1 If diagnosed early and precisely, most lymphomas in children and young adults have excellent cure rates of up to 90% using affordable treatments from the essential medicine list by the World Health Organization.2-6 In contrast, prolonged time-to-diagnosis and treatment usually results in poor treatment outcomes, especially in aggressive lymphoma types.7 In sub-Saharan Africa (SSA), cited causes of delay in diagnosis and treatment are low socioeconomic status, poor health-seeking behavior and access to health care, an inefficient health care referral system, a shortage of trained experts, and limited diagnostic capability.8,9 Studies analyzing delays in the diagnosis and treatment of lymphoma in SSA are limited. An objective assessment of the time to definitive care and associated factors is crucial in identifying intervention points along the pathway to care for patients with lymphoma in resource-restricted regions.

Here, we present the results of a prospective multicenter study involving 2 East African countries that evaluates both patient and health care–related delays among children and young adults diagnosed with lymphoma. The study was conducted at 3 tertiary cancer hospitals in Tanzania and 1 cancer center, St Mary’s Hospital-Lacor Hospital, in Northern Uganda. The centers in Tanzania included Muhimbili National Hospital in Dar es Salaam, Kilimanjaro Christian Medical Centre in Kilimanjaro, and Bugando Medical Centre in the Mwanza region, north of Tanzania. Ethical approval was granted by the Oxford Tropical Research Ethics Committee, the National Institute of Medical Research in Tanzania, the Uganda National Council of Science and Technology, and the Lacor Hospital Institutional Research Ethics Committee in Uganda. The AI-REAL study enrolled children and young adults (aged 3-30 years) presenting with suspected lymphoma. Here, we focus on the subset of patients with a biopsy-confirmed lymphoma diagnosis. For all enrolled patients, demographic and baseline clinical data, including the date they first experienced symptoms, the date they first visited a local health care center, and the date the local health care center referred them to the tertiary cancer center, were recorded. Upon arrival at the tertiary cancer treatment centers, the dates and times of tissue sampling, arrival of tissue in the pathology laboratory for processing and pathology reports (with and without immunohistochemistry), and start of definitive cancer treatment were recorded. The primary outcome was the median total treatment delay and its individual components. Total treatment delay was defined as the time from the onset of symptoms to the start of definitive cancer treatment. The total treatment delay included the time-to-first health care contact (from the onset of symptoms) to contact with the first health care facility, excluding the visit to traditional healers, time-to-referral (from the first health care facility contact to arrival at a cancer treatment center), and time-to-treatment after arrival at a cancer center (time from arriving at a cancer treatment center to receiving definitive cancer treatment). Time-to-diagnosis was defined as the time from arrival at a cancer center to receiving a tissue diagnosis report, either a morphology report alone or a morphology with immunohistochemistry (IHC) report.