Aims To examine referral volume, incomplete diagnostic work-up and residual patient harms in a high-demand regional medical oncology service.
Methods Retrospective audit of all 678 referrals to Hervey Bay Cancer Care Services from 1 July 2024 to 30 June 2025. Case-mix, acceptance and decline rates, triage performance against category benchmarks, and patients with disrupted care pathways were analysed.
Results The service accepted 481 new patients (2.0 FTE medical oncologists). Median age was 71 years; 51.4% had stage 4 disease. Thirty patients were already waiting at baseline. Referrals were triaged as category 1 (n=432), category 2 (n=45) and category 3 (n=4). One hundred and ninety-one referrals (28.2%) were declined, predominantly for lack of tissue diagnosis (n=87).
Category 1 compliance was 90.7%. Multidisciplinary team discussion was associated with shorter time to appointment (mean 14.4 vs 30.5 days). Specialised cancer nurses also supported timely access (mean difference 8.6 days, p<0.001). Priority flagging reduced waits for curative-intent and highly symptomatic patients.
Despite this performance, residual harms occurred. Forty Category 1 patients (9.3%) breached the 30-day target (mean extra delay 12.7 days), falling outside the evidence-based Optimal Care Pathway framework. In addition to capacity, the main reason for these delays was waiting for additional staging investigations such as PET or molecular results (n=10).
Disrupted pathways included deaths (n=17), symptomatic inpatient admissions (n=22), patients who declined further investigation or treatment (n=25), transfers to private care (n=14), and patients accepted but later found unfit for treatment (n=5).
Conclusions Residual waiting-time breaches and disrupted care pathways show that strong process metrics alone do not eliminate patient-level harm in a high-pressure regional service. Findings highlight the structural burden on regional cancer care, the need for improved referrer education on diagnostic pathways, and the advocacy advantage conferred by specialised cancer nurses.