Background: Cancer, one of the most important public health problems, requires early diagnosis and timely treatment to achieve favorable outcomes. Standardized care pathways are essential to achieve best outcomes.
Objectives: This study aimed to examine the cancer care pathway, focusing on patient-, disease-, and health-care provider– and system-related causes of delay, as defined by the World Health Organization.
Methods: This multicenter descriptive study was conducted using face-to-face questionnaires among 201 patients aged ≥18 years who resided in Ankara, were diagnosed with cancer in 2022, and were receiving treatment in the chemotherapy units of tertiary-level hospitals. Due to exclusion criteria, 151 patients were included in the final analysis. Survey data were collected during face-to-face interviews using Google Forms and analysed with SPSS version 26.0. For the interpretation of delays, a 28-day threshold was applied to each individual interval. Following descriptive and comparative analyses, binary logistic models were applied to identify risk factors for delays, with delay durations analysed as both categorical and continuous variables. Statistical significance was defined as p < 0.05.
Results: The median time from first symptom to first presentation at a health-care facility was 14 days (IQR: 2–92); from first presentation to the first diagnostic procedure, 31 days (IQR: 13.75–71.75); from the first diagnostic procedure to microscopically confirmed diagnosis, 12.5 days (IQR: 7–19); and from confirmed diagnosis to initiation of first treatment, 13 days (IQR: 2.75–31). The median total time from symptom onset to treatment initiation was 135 days (IQR: 77–235). Within the overall pathway, the proportional contribution of these four intervals was 19.9%, 44.0%, 17.7%, and 18.4%, respectively. Patient-related delays prior to first health-care contact were significantly associated with lower educational level (OR = 2.61, 95% CI: 1.05–6.52), having children (OR = 4.03, 95% CI: 1.22–13.30), and attempts at self-management of symptoms (OR = 2.88, 95% CI: 1.26–6.57). From first presentation at a health-care facility to the first diagnostic procedure, delays were significantly associated with the status of the diagnostic center (governmental vs. private; OR = 5.12, 95% CI 1.28–20.57) and malignancy group (rare vs. common cancers; OR = 2.85, 95% CI 1.002–8.11). Patients who sought diagnosis and treatment in governmental hospitals were also more likely to experience delays in the interval from first presentation to microscopically confirmed diagnosis (OR = 5.93, 95% CI 1.23–28.56).
Conclusions: Delays across the cancer care pathway were substantial, with the longest interval occurring between first health-care presentation and initiation of diagnostic procedures. Patient-related factors primarily influenced delays before first presentation, whereas malignancy type and health system characteristics, particularly the status of the health-care institution, were the main determinants of diagnostic delays. These findings highlight the need for standardized care pathways and strengthened referral systems to reduce institutional disparities and ensure timely cancer diagnosis and treatment initiation.

Median durations (panel A) and proportional distribution of time intervals (panel B) across key stages of the cancer care pathway