Background: Access to early detection facilities coupled with access to comprehensive treatment without delay can significantly improve cancer survival and help achieving the UN Sustainable Development Goals (target 3.4 to reduce premature mortality from cancer) and strengthening the cancer care pathways to attaining Universal Health Coverage. Pattern of care (POC) studies are crucial to provide evidence on the utilization of cancer care services in any given settings.
Objectives: Our study in Nepal aimed to quantify the intervals (and delays) across diagnosis pathway and assess its impact on stage at diagnosis across the six common cancers, namely breast, cervical, colorectal, lung, oral, and stomach cancers.
Methods: DECAN study recruited a multi-cancers cohort of 1,182 consecutive patients newly registered over six months (June-November 2022) at the largest comprehensive oncology center (BPKMCH) in Nepal. After informed consent, patients participated in face-to-face interview using a semi-structured questionnaire to document their socio-demographic status and various time-points (symptom recognition, diagnosis, treatment initiation). These time-points were also verified from the patients’ medical records, which were also the source of clinical and pathological data.

Results: The results showed strikingly long duration (median ranges from 110 to 171 days) from recognition of symptoms to start of treatment, irrespective of the diagnosed cancer type. The fourth quartile (75th – 100th percentile) of patients waited for more than six months till the start of treatment highlighting critical delays in cancer care pathway. Patients at an older age and those belonging to low socio-economic status were particularly vulnerable to late diagnosis. Lung cancer showed the highest adjusted odds of advanced-stage disease (OR= 5.47, 95%CI 2.98–9.14), compared to colorectal cancer (as reference), followed by stomach cancer (OR=2.67, 95%CI 1.43–4.30) in both sexes combined.

Conclusion: We highlighted unacceptable delays in accessing diagnostic and treatment services for patients suffering from common cancers in Nepal. Integrated multidisciplinary and contextually appropriate strategies to reduce the pre-diagnostic and diagnostic intervals and improving access to treatment can significantly improve cancer outcomes and reduce bottlenecks in cancer care pathways, and in doing so, Nepal can improve early cancer diagnosis goals as set by WHO.

Prediagnostic, diagnostic and treatment intervals in patients diagnosed with adult cancers (namely breast, cervical, colorectal, lung, oral and stomach cancers) in Nepal