# name
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.

# metadata.dc.description.abstract[].value
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.

# metadata.dc.rights[].value
cc-by (c) Vázquez, María Luisa et al., 2026

# metadata.dc.source[].value
Articles publicats en revistes (Ciències Clíniques)

# metadata.dc.title[].value
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.