Abstract Background Delayed diagnosis and treatment remain major contributors to poor lung cancer outcomes in Mexico, where fragmented service delivery and weak referral coordination shape patient trajectories. Integrating patient narratives with measurable time intervals is critical to understanding how health system structures translate into lived delays and inequities. Methods We conducted a convergent mixed-methods study using routinely collected electronic health record data and structured patient interviews at the National Cancer Institute of Mexico (INCAN). Relevant dates were extracted for all suspected lung cancer patients admitted between 2004 and 2021 ( N = 2,645). Descriptive statistics, interval calculations, pathway classification, and temporal trends were drawn. In parallel, a purposive subsample of patients ( N = 46) participated in structured interviews exploring symptom appraisal, help-seeking, travel, and interactions with health services. Quantitative and qualitative data were collected concurrently and analysed independently with equal priority. Open-ended interview data were analysed thematically, and structured electronic health record data were quantified. Integration then occurred through joint displays combining interview-derived data with medical record variables to link measured delays and clinical pathways with patients’ contextual characteristics and reconstruct individual care journeys. Results Four diagnostic pathways were identified, reflecting where and how diagnosis occurred in N = 2645 patients. Median time from first symptom to treatment ranged from 160 to 255 days, with substantial variation by pathway and year of admission. Interviews revealed N = 41 patients were symptomatic at the time of first appraisal. Recurrent patterns of delayed self-appraisal ( N = 61 (median days to first encounter after first symptom), misdiagnosis ( N = 24), fragmented referrals, financial insecurity, and long-distance travel to access specialised care. Patients commonly navigated multiple public and private providers before reaching INCAN with very few arriving solely from a public pathway, reaching a median of 3 medical encounters before diagnosis, and thus often incurring out-of-pocket costs and experiencing interruptions in care. Conclusions Stratifying lung cancer outcomes by diagnostic pathway and linking interval-based metrics to patient experience reveals how health system fragmentation generates avoidable delays and inequities. Policy responses should prioritise coordinated referral pathways, strengthened regional diagnostic capacity, financial protection mechanisms, and early detection competencies across levels of care.
Bautista-González et al. (Wed,) studied this question.