August 2025, BMC Cancer, an open-access, peer-reviewed journal published by Springer Nature, has released the article: “Bulgarian exploratory analysis of time from diagnosis to treatment of lung cancer patients (BEAT): a retrospective database study on the patient pathway and time to treatment.”
This Real-World Evidence (RWE) study, co-authored by leading Bulgarian oncologists, MSD Bulgaria, Sqilline Health, and academic partners, provides the first nationwide analysis of lung cancer treatment pathways in Bulgaria. It examines diagnostic stage, treatment initiation, and time-to-treatment (TTT) across therapy types and regions.
Sqilline’s Danny Platform powered the study by structuring fragmented hospital EHRs into research-ready datasets, enabling national-level insights. The retrospective analysis included 7,098 lung cancer patients diagnosed between 2020 and 2022 across 36 hospitals in 7 regions, mapping stage at diagnosis, initial treatment choices, and time from diagnosis to treatment (TTT).
Introduction
Lung cancer is the leading cause of cancer mortality in Bulgaria, with a large proportion of patients diagnosed at advanced stages. Timely treatment initiation is critical for outcomes, but little real-world evidence exists on national treatment timelines..
Key Summary Points
Objectives
- Evaluate time from diagnosis to first treatment (systemic therapy, radiotherapy, surgery, or combination).
- Compare regional differences in time-to-treatment.
- Assess disease type, stage at diagnosis, and first-line treatment choices in real-world practice.
Challenges
- High rates of late-stage diagnosis (61% Stage IV at baseline).
- Regional disparities in treatment timelines.
- Fragmented, unstructured hospital EHRs require advanced structuring.
Solution
Danny Platform enabled:
- Structuring of heterogeneous hospital data into standardized, analyzable datasets.
- Consistent survival and time-to-treatment analysis across 36 centers.
- Regional and therapy-type comparisons to identify bottlenecks in care.
Results
Patient Cohort
- Total diagnosed with lung cancer (2020–2022): 8,585 patients (~2,861/year)
- Included (no other malignancies): 7,098 patients
- Type at diagnosis:
- NSCLC 64% (4,536)
- SCLC 12% (890)
- missing 23% (1,672)
- Stage IV at diagnosis: 61% (4,297 patients)
Treatment (n = 4,383 eligible patients):
- Systemic therapy: 74% (3,239)
- Radiotherapy: 22% (984)
- Surgery: 2% (95)
- Combination systemic + RT: 1% (65)
First Systemic Therapy (n = 3,239):
- Chemotherapy: 43% (1,404)
- Chemo + Immunotherapy: 31% (1,007)
- Immunotherapy monotherapy: 11% (371)
- Targeted therapy (any): ~15% combined
Time-to-Treatment (Median, National):
- Diagnosis → Systemic therapy: 42 days
- Diagnosis → Radiotherapy: 29 days
- Ambulatory → Systemic therapy: 12 days
- Ambulatory → Surgery: 10 days
- Regional medians ranged widely: e.g., systemic therapy 7 days (South-Western) vs. 29 days (North-Eastern)
Conclusions
- Confirms a late-stage diagnosis burden (Stage IV: 61%) and significant regional disparities in TTT.
- Supports the need for screening programs, equitable distribution of oncology services, and process optimization to reduce delays.
- Demonstrates how dynamic, harmonized patient registries—enabled by Danny Platform—can power national real-world studies for policy and care-pathway improvement.
Authors & Affiliations
Assen Dudov — Acibadem City Clinic Mladost, Sofia, Bulgaria
Nikolay Conev — University Hospital St. Marina, Varna, Bulgaria
Mila Petrova — Nadezhda Hospital, Sofia, Bulgaria
Ivan Tonev —Complex Oncology Center, Plovdiv, Bulgaria
Martina Nacheva — Sqilline, Sofia, Bulgaria
Maria V. Dimitrova — MSD Bulgaria, Sofia, Bulgaria
Maria J. Dimitrova — Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria (Corresponding author)
