Delays and detours during cancer diagnosis: a cross-sectional study on patient pathways and provider intervals in public healthcare networks of Chile, Colombia and Ecuador.

Abstract

Background The longest delays in cancer diagnosis in Latin America occur between the first contact with health services and the confirmation of diagnosis (referred to as the provider interval), yet few studies have examined patient pathways to understand these delays. This study aims to analyze patient diagnostic pathways and their relationship to the provider interval in public healthcare networks of Chile, Colombia and Ecuador. Methods Cross-sectional study based on questionnaire survey to adult patients diagnosed with cancer in prior 12 months in the study networks (n=351 in Chile; 303 in Colombia; 365 in Ecuador). Study variables were diagnostic pathways (according to type and sequence of services) and provider intervals. Descriptive, bivariate and adjusted multivariate quantile regression analyses were conducted. Results Two pathway types were identified: a) public services use, frequent in Colombia (67.3%) and b) mixed public-private services use, predominant in Chile (76.9%) and Ecuador (59.2%). Under 20% of patients followed the public pathway starting in primary care followed by referral to secondary care for confirmation. In Colombia and Ecuador, it was common to start in emergency departments, and in Colombia, going back and forth between care levels. Median provider interval was 111 days (IQR:134) in Chile, 156 (IQR:275) in Colombia and 92 (IQR:173) in Ecuador. Public-private pathways, more frequent in symptomatic patients, were significantly longer than public-only pathways (Chile: 116 vs. 92 days; Colombia: 175 vs. 153 days; Ecuador: 92 vs. 75 days; all p<0.05). Emergency-initiated pathways were significantly shorter, whereas Colombia’s back-and-forth pathways were longer than those via primary care, although this difference was not statistically significant. Conclusion The results reveal fragmented diagnostic pathways with significant delays, particularly in Colombia. The results underscore the need for equity-oriented policies to improve access to care in public healthcare networks.