Time to haematologist visit and non-haematological referral from primary health care during blood cancer diagnosis – findings from a large national survey in Australia

BACKGROUND: Blood cancers are the third most common cancer in Australia. However, little is known about their diagnostic pathway in the Australian context. This research aimed to assess the interval between first primary health care (PHC) contact and first haematologist visit, and referrals to specialists other than haematologists (non-haematological referrals) during blood cancer diagnoses. METHODS: An online national survey was conducted with patients living with blood cancers, such as leukaemia, lymphoma, multiple myeloma, myeloproliferative neoplasms (MPN) and myelodysplastic neoplasms (MDS) between October and November 2022. Univariate and adjusted logistic regression models were applied to examine sociodemographic factors (age, sex, income, residence location, country of birth, private health insurance) and type of blood cancers associated with extended PHC-haematologist visit intervals (> 1-month) and non-haematological referrals. RESULTS: Of the total 1758 participants, 26.3% (95% CI 24.3, 28.4%) patients experienced an extended PHC-haematologist visit interval (> 1-month) and of 1749 participants, 24.8% (95% CI 22.8, 26.9%) patients experienced non-haematological referrals during their diagnosis stage. Women were more likely to report an extended PHC-haematologist visit interval (adjusted odds ratio aOR 1.38, 95% CI 1.10, 1.73) or non-haematological referrals (aOR 1.42, 95%CI 1.12, 1.80). Regional Australians (aOR 1.37, 95%CI 1.08, 1.73) were more likely to experience an extended PHC -haematologist visit interval, but the odds of non-haematological referrals was not significant for them. Being older (≥ 65 years) (aOR 0.59, 95% CI 0.36, 0.97) and overseas-born (aOR 0.73, 95%CI 0.54, 0.99) were associated with a lower likelihood of non-haematological referrals. Private insurance holders (aOR 1.19, 95% CI 1.05, 1.35) were also more likely to have specialist referrals other than haematologists. Patients with an indolent type of blood cancers, such as lymphomas, multiple myeloma and MDS, are more likely to experience an extended PHC-haematologist visit interval or non-haematological referrals. CONCLUSIONS: A multi-pronged approach, including raising awareness of blood cancer signs and symptoms among both patients and health care professionals and improving access to GPs and specialist services, particularly in regional and rural Australia, is required to improve timely help-seeking during diagnosis. More evidence is also needed on clusters of non-specific symptoms indicative of haematological cancers underpinning guidelines and optimal care pathways to support possible use of automated software prompts and prompt diagnosis.