In an illuminating new retrospective database study published in BMC Cancer, Bulgarian researchers have unveiled critical insights into the patient journey of lung cancer, focusing specifically on the interval between diagnosis and treatment initiation. Lung cancer remains a formidable health challenge worldwide, and Bulgaria is no exception. According to data compiled by Globocan for the year 2020, Bulgaria faces the highest cancer mortality rate attributed to lung cancer, which ranks as the third most common malignancy and the leading cause of cancer-related deaths nationwide. This study meticulously charts the pathway of patients from the point of initial diagnosis to the administration of their first treatment, revealing significant time delays and regional disparities that could impact outcomes.
The researchers analyzed real-world data retrospectively over a three-year period (2020 to 2022) gathered from national and regional databases originally compiled for other healthcare purposes. Employing an observational design, the study refrained from experimental intervention but focused heavily on descriptive statistical methods to characterize treatment timelines for lung cancer patients on a population scale. The main metrics scrutinized were the time intervals from confirmed diagnosis through to the initiation of various treatment modalities, including surgical and systemic therapies. Additionally, the analysis profiled newly diagnosed cases by year to detect temporal trends in incidence and treatment patterns.
Findings from this extensive patient population highlight that over the observed period more than 8,500 lung cancer cases were identified, averaging approximately 2,861 new cases each year. Notably, a large proportion of these patients—approximately 64%—were diagnosed with non-small cell lung cancer (NSCLC), which is consistent with global epidemiological trends. What is particularly alarming is that a majority of patients presented with advanced disease, with 61 percent (nearly 4,300 patients) being diagnosed at Stage IV, indicating metastatic progression at the time of clinical detection. This late-stage diagnosis often correlates with poorer prognoses and limited treatment options, heightening the need for early detection strategies.
The time from diagnosis to the initiation of the first treatment revealed considerable variability contingent upon the geographic region and type of therapy administered. Surgical treatments showed the shortest median time intervals, ranging from as low as 7 days to as long as 40 days depending on the local healthcare infrastructure and resource availability. By contrast, combination therapies—which typically involve a blend of chemotherapy, radiation, and targeted agents—exhibited a starkly longer median latency, spanning from 26 to 85 days before commencement. These delays underscore systemic bottlenecks and highlight disparities in access to advanced oncological care across different Bulgarian regions.
Further scrutiny of systemic treatment initiation, which encompasses chemotherapy and immunotherapy administration, revealed a median delay of 42 days from diagnosis. Such a protracted interval raises concerns regarding the potential impacts on tumor progression and overall patient survival. In the context of lung cancer, where rapid progression is characteristic, treatment delays can substantially compromise clinical outcomes. This study thereby accentuates the urgency of streamlining diagnostic-to-treatment workflows to reduce such lag times and optimize patient survival.
The study also underscores the critical importance of maintaining dynamic and comprehensive patient registries in oncology. These real-world data repositories offer invaluable opportunities to evaluate treatment patterns, identify healthcare inequities, and monitor temporal changes in disease incidence and management. Without such databases, it would be challenging to perform large-scale epidemiological analyses or design targeted interventions to bridge care gaps.
Importantly, the findings highlight systemic shortcomings within the Bulgarian healthcare system, especially the lack of organized lung cancer screening programs. Unlike breast or colorectal cancer, lung cancer screening via low-dose computed tomography (CT) scans is not standard practice in Bulgaria, a deficit that contributes to late-stage cancer detection. The study’s authors advocate strongly for the establishment of population-wide screening initiatives, which could lead to earlier diagnosis, more effective treatment, and ultimately, improved survival rates.
Moreover, the research calls attention to the uneven distribution of oncology centers across Bulgaria, which fosters regional inequities in care delivery. Patients residing in rural or underserved areas face longer delays and limited access to specialized treatments, implicating social and geographic determinants of health in cancer outcomes. Policymakers are urged to address these disparities through decentralization of cancer care resources and enhanced regional healthcare capacity building.
The robustness of this retrospective analysis is further emphasized by its comprehensive scope and multi-level stratification of outcomes. By categorizing data according to years, regions, therapy types, and cancer stages, the study offers a granular picture of the Bulgarian lung cancer landscape. It enables stakeholders to pinpoint specific bottlenecks and optimize resource allocation with evidence-based strategies tailored to regional needs.
The implications of these findings extend beyond Bulgaria. Many countries face similar challenges regarding late diagnosis, treatment delays, and inequities in cancer care. This study thus serves as a model for integrating secondary data use in oncology research and highlights how real-world evidence can drive improvements in clinical pathways globally.
In conclusion, this groundbreaking analysis not only delineates the pressing clinical challenge of treatment wait times in Bulgarian lung cancer patients but also advocates for systemic reforms. Enhanced data infrastructure, implementation of targeted screening programs, and equitable distribution of oncology services stand out as cardinal interventions necessary to improve the prognosis and quality of life for these vulnerable patients.
As the global fight against lung cancer intensifies, studies such as this provide invaluable insight into the real-world hurdles patients face after their diagnosis. Tackling these delays head-on offers a pathway to reducing mortality. With lung cancer’s devastating impact on populations worldwide, every day gained from improved management timelines can translate into precious months—or years—of life beyond diagnosis.
Future research will need to delve deeper into the socioeconomic barriers impacting patient pathways, the molecular characteristics influencing treatment responsiveness, and the deployment of innovative therapeutic options under real-world constraints. Nonetheless, the current findings deliver a powerful impetus for Bulgarian health authorities to reimagine and revamp cancer control strategies, elevating care standards to meet international benchmarks.
This study stands as a testament to the power of data-driven healthcare reforms and the necessity of relentless vigilance in the battle against lung cancer, a disease still claiming countless lives globally. As healthcare systems evolve, such analytical endeavors will remain essential to understand and dismantle the invisible barriers obstructing timely, effective cancer care.
Subject of Research: Lung cancer patient pathways and time from diagnosis to treatment in Bulgaria.
Article Title: Bulgarian exploratory analysis of time from diagnosis to treatment of lung cancer patients (Beat) – a retrospective database study on the patient pathway and time from diagnosis to treatment.
Article References:
Dudov, A., Conev, N., Petrova, M. et al. Bulgarian exploratory analysis of time from diagnosis to treatment of lung cancer patients (Beat) – a retrospective database study on the patient pathway and time from diagnosis to treatment. BMC Cancer 25, 1384 (2025). https://doi.org/10.1186/s12885-025-14228-3
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