Fast-track or non-fast-track pathways? Association with prognosis and mortality in cancer patients: A nationwide...

Timely cancer diagnosis is critical for prognosis. Fast-track pathways, aim to expedite diagnosis, but it is unclear whether benefits apply equally across cancer types, particularly those that are diagnostically challenging. We examined whether diagnostic routes (fast-track versus non-fast-track) were associated with stage at diagnosis and one-year mortality and stratified by cancer type and diagnostic difficulty.

A nationwide registry-based cohort study of 118,686 Danish adults diagnosed with first-time cancers between 2018 and 2022. Patients were grouped by diagnostic route in fast-track or non-fast-track (unplanned/planned admission). Odds ratios (OR) for stage I diagnosis was estimated by logistic regression. Cox proportional hazards regression estimated hazard ratios (HRs) for one-year all-cause mortality, and Fine-Grey models estimated sub-distribution hazard ratios (SHRs) for cancer-specific mortality.

Most cancers were diagnosed through fast-track pathways (96,644, 81.4%). Compared with fast-track, unplanned admission was associated with lower odds of stage I diagnosis (OR 0.25, 95% CI: 0.22-0.29), whereas planned admission had higher odds (OR 1.50, 95% CI: 1.42-1.59). Unplanned admission was associated with higher one-year mortality (HR 4.12, 95% CI: 3.97-4.27), while the earlier stage at diagnosis in planned admission did not improve mortality (HR 1.05, 95% CI: 1.01-1.09). While this trend was consistent across cancers in unplanned admission, associations with mortality varied across cancers for planned admission.

Diagnosis through fast-track pathways was associated with more favourable stage and survival outcomes, whereas unplanned admission was associated with the poorest prognosis.