Lymphoma: factors associated with unplanned diagnostic pathways and survival –a nationwide Danish register-based cohort study

The objective was to investigate how patient characteristics, clinical characteristics and prognosis were associated with lymphoma diagnoses in unplanned pathways. We included 7,157 consecutive patients diagnosed with lymphoma in a nationwide register-based study in Denmark. An unplanned pathway was defined as an acute admission within 30 days before diagnosis and compared to all other pathways combined. A total of 21% of patients were diagnosed in unplanned pathways, varying from 13% in indolent non-Hodgkin lymphoma to 32% in aggressive non-Hodgkin lymphoma. The probability of being diagnosed in an unplanned pathway was higher for patients with comorbidity, B-symptoms, abnormal blood test results, advanced disease stage and poor performance score (PS) at diagnosis. Diagnosis in an unplanned pathway was associated with higher mortality, for example, HR 2.03 (95% CI:1.74-2.38 for PS 0). Increased disease severity at diagnosis was associated with unplanned diagnostic pathways. Diagnosis in an unplanned pathway was associated with higher mortality.