{
  "abstract": "Background\n\nCancer of Unknown Primary (CUP) is a heterogeneous group of cancers for which a primary site cannot be identified. The diagnostic pathway is often protracted and resource-intensive, with little known about the costs involved. The primary aims of this study were to (a) determine time-to-treatment-decision (pathway duration) and (b) estimate resources incurred and direct healthcare costs within the UK's diagnostic pathway.Methods\n\nA microcosting analysis was conducted on 370 patients with CUP. For relevant context, a comparison cohort of 216 patients with stage IV cholangiocarcinoma (CCA) was selected. Pathways were mapped from the first cancer-related investigation until treatment decision. Analyses estimated pathway duration and cost, and explored the significance of prognostic variables on the CUP pathway.Results\n\nMedian pathway duration in CUP was 40% longer than CCA (2.8 months vs 2.0 months, respectively, p < 0.001). Mean per-patient cost of the CUP pathway was 62% higher than CCA (£3902 vs £2403 respectively, p < 0.001). Performance status 0-1 and squamous-cell histology were predictive of higher costs in CUP.Conclusions\n\nDirect healthcare costs were significantly higher in CUP. Improvements are required to rationalise investigations and facilitate patients receiving treatment in an appropriate timeframe.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK. laura.spurgeon@nhs.net.",
    "Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK. laura.spurgeon@nhs.net.",
    "Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.",
    "Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.",
    "National Biomarker Centre, Paterson Building, Manchester, UK.",
    "Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Laura Spurgeon",
      "orcid": "0000-0003-4152-5068"
    },
    {
      "affs": [
        2
      ],
      "name": "Claire Mitchell"
    },
    {
      "affs": [
        2,
        3,
        4
      ],
      "name": "Alicia-Marie Conway"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Natalie Cook"
    },
    {
      "affs": [
        5
      ],
      "name": "Sean P Gavan",
      "orcid": "0000-0003-3659-056X"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1nr6xgqw1t6w1.bib",
  "cited_by": 0,
  "doi": "10.1038/s44276-026-00252-8",
  "fulltext_url": "https://europepmc.org/articles/PMC13694267",
  "id": "1nr6xgqw1t6w1",
  "issns": [
    "2731-9377"
  ],
  "landing_url": "https://europepmc.org/article/MED/42919843",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC254-282"
    ],
    [
      "openalex",
      "2730|Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7223324897",
  "pdf_url": "https://europepmc.org/articles/PMC13694267?pdf=render",
  "pmcid": "PMC13694267",
  "pmid": "42919843",
  "published": "2026-10-23",
  "publisher": "Nature Portfolio",
  "ris": "https://research.draconitic.com/paper/1nr6xgqw1t6w1.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:33Z",
      "native_id": "MED:42919843",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42919843"
    },
    {
      "first_seen": "2026-10-30T13:45:50Z",
      "native_id": "e944c227acbf49ba93fd1ea269a67053",
      "source": "doaj",
      "url": "https://doi.org/10.1038/s44276-026-00252-8"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Cancer Diagnosis and Treatment",
      "subfield": "oncology"
    }
  ],
  "title": "The Cost of Uncertainty: A Microcosting Analysis of the Cancer of Unknown Primary Diagnostic Pathway.",
  "title_text": "The Cost of Uncertainty: A Microcosting Analysis of the Cancer of Unknown Primary Diagnostic Pathway.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:45:50Z",
  "url": "https://research.draconitic.com/paper/1nr6xgqw1t6w1",
  "venue": "BJC reports",
  "versions": []
}