Data-science audit of oncology cards 2015–2021 in Poland: ICD-10 differences and time to treatment

Abstract Background Despite multiple initiatives and modern diagnostic/therapeutic technologies, Polish cancer care is still hampered by uneven access and long waiting times. To address these gaps, the 2015 oncology fast-track introduced the Diagnostic and Therapeutic Oncology Card (DiLO, “green card") to accelerate the diagnostic-treatment pathway, yet its real-world effect requires further evaluation and optimisation. Methods We performed a retrospective cohort study of 11 560 patients hospitalised for malignant or borderline tumours (ICD-10 C00-C96, D37-D44, D47-D48) at T. Mikulicz-Radecki University Hospital, Wrocław, 2015-2021. Hospital-information-system records were linked with National Health Fund data on DiLO issuance. Overall, 9 364 patients (81 %) held ≥ 1 card (G2) and 2 196 held none (G1). For each ICD-10 group we compared (i) time from first oncology encounter in the public system to first hospital admission (TTI) and (ii) overall survival. Mann-Whitney tests and multivariable Cox models assessed differences. Results Median TTI was longer in G2 than G1 (48 vs 20 days, p < 0.01). The delay persisted in major cancers: lung C34 48 vs 24 days (p < 0.05); colorectal C18 48 vs 21 days (p = 0.007); prostate C61 73 vs 27 days (p < 0.001); bladder C67 7 vs 0 days (p = 0.013). Duplicate cards or logical inconsistencies affected ≥ 8 % of patients. Despite delays, median survival was longer in G2 for some tumours, e.g. bladder cancer 5.27 vs 3.34 years (p < 0.001) and neoplasms of uncertain or unknown behaviour (D38) 3.61 vs 2.67 years (p < 0.001). Conclusions Holding a DiLO card is paradoxically linked to substantial diagnostic-to-treatment delay across leading cancers, although selected groups show better survival. Frequent duplication and data errors indicate that administrative rather than clinical factors drive card issuance. Standardisation and automatic validation of DiLO workflows could reduce inequities and translate into better population survival. Key messages • Patients with a card waited a median 28 days longer for hospital care; delays were significant in lung, colorectal, prostate and bladder cancer. • Streamlined, automatically validated card workflows are essential to fulfil the fast-track promise and improve outcomes.