ArticleBMJ global health2025
A comprehensive assessment of intervals in care pathways among cancer patients in a limited resourced setting: results of a prospective patterns of care study in 2022 in Nepal.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- From evidence to action: the IARC's role in strengthening cancer prevention and early detection.Journal of the National Cancer Institute. Monographs · 2026Review
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Abstract
backgroundPattern of care studies are crucial to provide evidence on the utilisation of cancer care services in any given settings. Our study in Nepal aimed to quantify the intervals (and delays) across the diagnosis pathway and assess its impact on stage at diagnosis across six common cancers.
methodsDElays in CAncer care in Nepal (DECAN) study recruited a multicancer cohort of 1182 consecutive patients newly registered over 6 months (June-November 2022) at the largest comprehensive oncology centre (B.P. Koirala Memorial Cancer Hospital) in Nepal. After informed consent, patients participated in face-to-face interviews using a semistructured questionnaire to document their sociodemographic 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. Statistical analyses were conducted using ORs with 95% CIs and p-values <0.05 were considered statistically significant.
resultsThe 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 6 months till the start of treatment highlighting critical delays in cancer care pathway. Old-aged and low socioeconomic status patients were particularly vulnerable to late diagnosis. Lung cancer showed the highest adjusted odds of advanced-stage disease (OR=5.47, 95% CI 2.98 to 9.14), compared with colorectal cancer (as reference), followed by stomach cancer (OR=2.67, 95% CI 1.43 to 4.30) in both sexes combined.
conclusionWe 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 prediagnostic and diagnostic intervals and improve treatment access 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.
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