Patterns of Pediatric Cancer Care at a Tertiary Center in Pakistan: A Hospital-Based Registry Analysis.
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BACKGROUND: Childhood cancer outcomes remain poor in many low- and middle-income countries, in part due to delays in diagnosis, incomplete staging, and health system constraints. However, detailed site-level descriptions of pediatric oncology care pathways in South Asia remain limited. METHODS: We conducted a descriptive observational analysis using routinely collected data from a hospital-based pediatric cancer registry at the Children's Hospital Lahore. Children and adolescents (<18 years) registered between July 2021 and April 2026 were included. We summarized demographics, cancer type distribution, diagnostic confirmation methods, treatment intent, care timelines from symptom onset to treatment initiation, and documented mortality outcomes. RESULTS: A total of 7583 children were registered. Median age at diagnosis was 5 years, and 61.2% were male. Leukemias and lymphomas accounted for 50.2% and 12.8% of confirmed diagnoses, respectively, with acute lymphoblastic leukemia the most common diagnosis (41.4%). Microscopic verification was achieved in over 90% of cases. Median time from symptom onset to first medical assessment was 25 days, and median time from diagnosis to treatment initiation was 2 days. Curative-intent treatment was initiated in over 80% of patients. Among patients with available follow-up data, 1437 deaths were documented, with longitudinal outcome data varying in maturity as follow-up accumulated through subsequent registry forms. CONCLUSIONS: This large registry-based descriptive analysis provides a comprehensive overview of pediatric cancer presentation, diagnostic pathways, and treatment timelines at a major referral center in Pakistan. Findings demonstrated strengths in diagnostic confirmation and rapid treatment initiation following diagnosis, while identifying gaps including delays before first medical assessment and a substantial burden of infection-related mortality. This work demonstrates the feasibility of implementing large-scale hospital-based cancer registries in resource-constrained settings to support quality improvement and health system strengthening.