Clinical Characteristics and Delays in the Care Pathway of Patients With Lung Cancer Treated at a Public Hospital in Costa Rica, 2015-2020

Introduction: Delays in the lung cancer care pathway and limited access to molecular biomarkers, targeted therapies, and immunotherapy may affect diagnosis, treatment opportunities, and survival.This study described the clinical profile, care pathway delays, biomarker testing, treatment access, and survival of patients with primary lung cancer treated at a public hospital in Costa Rica.Methods: We conducted a retrospective observational study based on medical record review.Adult patients with a pathological diagnosis of primary lung cancer treated at a public tertiary-level hospital in Costa Rica between 2015 and 2020 were included (n=223).Clinical, sociodemographic, and care process variables were analyzed, including symptoms at the time of consultation, smoking history, diagnostic and therapeutic time intervals, molecular biomarker testing, treatments received, and survival from the first care episode related to suspected lung cancer until death or the end of follow-up.Results: The most frequent symptoms before diagnosis were cough (n=126; 56.50%), dyspnea (n=110; 49.33%), and weight loss (n=98; 43.95%).The median time between documented suspicion and pathological diagnosis was 34 days (IQR: 21-73; n=213), although extreme values exceeding 1000 days were observed.Molecular biomarker testing was recorded in 106 patients (47.53%), and targeted therapy or immunotherapy was documented in 45 patients (30.00%).Among patients who received targeted therapy or immunotherapy, 29 (64.44%)accessed these treatments through administrative requests to higher institutional authorities outside the standard care protocol.The estimated five-year survival from the first care episode related to suspected lung cancer was 1.9% (95% CI: 0.5-5.1).Conclusions: This cohort showed frequent diagnostic delays, high variability in care pathway intervals, limited access to molecular biomarkers and innovative therapies, and low five-year survival from the first care episode related to suspected lung cancer.These findings support the need to strengthen suspicion, referral, timely diagnosis, and equitable access to diagnostic technologies and therapeutic alternatives for patients with lung cancer.