The Gordon and Betty Moore Foundation is funding health services research projects to expand the base of rigorous evidence about pre-hospital diagnostic delays – i.e., those that occur before a patient reaches the care setting where their condition is diagnosed. The goal of this study is to improve the understanding of pre-hospital delays for cancer diagnoses in rural, impoverished settings with racially diverse, un-, and under-insured individuals. The study population will include approximately 50,000 patients who were diagnosed with 16 different cancer types in North Carolina (NC). Researchers will use a mixed method approach and a unique linked data resource, the University of North Carolina Lineberger Cancer Information & Population Health Resource (CIPHR), which includes tumor details for all cancer-affected North Carolinians regardless of their source of healthcare, with linkage to Medicaid claims for Medicaid beneficiaries and electronic health records (EHRs) for patients treated at UNC Health. Statistical and geospatial analysis of CIPHR data will be complemented with focus groups to be conducted in the most at-risk communities within North Carolina among invited community outreach and engagement partners to better characterize the specific barriers to a timely cancer diagnosis. Epidemiologic and statistical analyses will undertake a comparison of the burden of early vs. late-stage cancers in NC with geographical hot spot maps of the areas most affected by advanced stage cancer diagnosis, and population statistics about the patient route to diagnosis (e.g., emergency department, screening, or ambulatory clinic). Researchers will also prepare a report on focus group feedback from the most affected communities on what interventions they would support. Deliverables will include a project work plan, narrative and financial reports, and a range of products to reach clinicians, policymakers, and other audiences for study findings.