The Patient Journey in Oncology: Access, Waiting, Referral and Transitions

The patient journey is the whole sequence of stages a person passes through from first contact with the health system to treatment and follow-up, together with the transitions between them. In oncology the journey typically runs through access, referral, diagnosis, pre-treatment waiting, treatment, care transitions and follow-up. What decides its quality is not only how well each stage is performed but how well the flow between stages, the waiting times and the access barriers are managed. This introductory (101) text, drawn from two Web of Science corpora on oncology and oncology management, walks through each link of the chain with a number attached and flags where weak links can harm patients.

Four building blocks

• Access is the gate of the journey: if the patient cannot reach the service, the journey never starts (Fundytus et al., 2021; Venkat et al., 2022).
• Time intervals are the periods from referral to diagnosis, diagnosis to treatment and between treatment steps; they can change outcomes (Dereje et al., 2021; Lai et al., 2020; Joneborg et al., 2021).
• Transitions and continuity are the hand-overs between people and institutions, where information loss and delay are most likely.
• Experience is how the patient perceives the whole journey, and it is a measurable quality indicator (Hashemi-Sadraei et al., 2021).

Geography, socioeconomic status and cost cut across every stage (Trommer et al., 2025; Gurney et al., 2024; Liu et al., 2023). The classic principle: improving the journey is less about speeding up individual steps than about reducing waiting and access barriers between them.

Access: the first and most unequal link

Globally, access to the cancer medicines oncologists consider essential diverges sharply by country income. A survey of 948 oncologists from 82 countries found access to core drugs markedly restricted in low- and lower-middle-income countries (Fundytus et al., 2021). Inequity is local too: among more than 36,000 bladder cancer patients eligible for chemotherapy, uninsured (odds ratio 0.47), rural (0.70) and Medicaid-covered (0.66) patients were less likely to receive it (Venkat et al., 2022). Strategic frameworks combining policy, infrastructure and capacity are being developed for resource-limited settings (Ramashia et al., 2025).

Waiting and time intervals

Of 178 women awaiting radiotherapy for cervical cancer, 16 (9.0%) died before treatment; among those treated the median wait was 137 days, 74.1% waited more than 60 days and the tumour progressed in 44.4% of them (Dereje et al., 2021). In 1,028 women with early-stage breast cancer, delays of 12 weeks from surgery to radiotherapy, or 6 weeks from chemotherapy to radiotherapy, were associated with worse event-free survival (Raphael et al., 2020). The interval from neoadjuvant chemotherapy to surgery has been studied in groups of under four, four to eight, and over eight weeks (Lai et al., 2020), and the interval to adjuvant chemotherapy after upper abdominal surgery in relation to postoperative complications (Joneborg et al., 2021).

Geography, travel and cost

About half of palliative radiotherapy patients were not treated at their nearest centre, travelling an average of 24 to 28 extra kilometres, with the burden falling disproportionately on rural and disadvantaged patients (Trommer et al., 2025). Centralising lung cancer treatment can improve outcomes while worsening access: in New Zealand, Māori patients were markedly more likely to live more than 200 km from a surgical centre (adjusted odds ratio 1.83) (Gurney et al., 2024). In prostate radiotherapy, total travel ranged from 242 to 1,616 km and taxi costs from EUR 638 to EUR 4,255 depending on the fractionation scheme (Wurschi et al., 2025), and average out-of-pocket spending per radiotherapy episode rose from about USD 1,186 to USD 1,611 over time (Liu et al., 2023). Together, distance, cost and choice can tie access to a patient’s wallet and postcode.

Referral, rapid access and flow design

Redesigning the journey can improve both flow and access. A same-day appointment offer made to 4,301 new radiation oncology referrals over two years was taken up by 14% of planned patients and improved access benchmarks (Chen et al., 2024). In an outpatient infusion clinic, real-time data and process redesign shortened the time from appointment to first drug and raised the Press Ganey satisfaction score from 76.2 to 85.1 (Hashemi-Sadraei et al., 2021). Timing of referral matters as much as speed: in 645 palliative radiotherapy patients, 30-day mortality was 15.8%, yet only 55% of those who died were referred to specialist palliative care and only 26.4% had a documented performance status (O’Leary et al., 2024).

The invisible barrier: iatrogenic delay

Some delay is produced by the system itself. Rigid neutrophil thresholds before chemotherapy can hold back patients who are in fact fit for treatment: when the blood count was repeated, 31 of 32 hesitated-over patients could be treated as planned (Waszczuk-Gajda et al., 2021). Not every delay is a clinical necessity.

Five warnings

• A queue is a patient list. Manage it by clinical urgency rather than first-come, first-served, and monitor cancer-specific waiting thresholds like adverse events.
• Access inequity is silent and systematic harm. Centralisation trade-offs should be actively managed with satellite centres, transport support and same-day appointments.
• Out-of-pocket cost and travel can make treatment unreachable. A patient who is medically eligible may still interrupt or abandon treatment because of distance or cost.
• Late referral predicts high early mortality. Referral pathways should be early and defined, with rapid access and early palliative care integration.
• Some delays are avoidable. Question delays to separate the necessary from the iatrogenic.

The durable principle

Shortening waits, widening access and making transitions safe, when done without compromising safety, is a direct clinical improvement. A queue is a patient list, an access barrier is an invisible abandonment of treatment, and not every delay is a clinical necessity.

Source chapter: Kurutkan, M. N. (2026). The patient journey in oncology: Managing access, waiting, referral and transitions (101 reading text). Oncology Hospital Management Training Series, supplementary chapter (original in Turkish).

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