Comprehensive Analysis of Factors Associated with Treatment Delays in Asian, Native Hawaiian, and Other Pacific Islander Patients with Colorectal Cancer.

Introduction: Colorectal cancer (CRC) is the second most common cause of cancer death in the USA. Many modifiable factors affect prognosis, including but not limited to diet, smoking, alcohol, and time of diagnosis to initial treatment (TTT). Studies have found that patients who had a delay in surgery of greater than one month during the COVID pandemic and a TTT of greater than 31 days were at increased risk of death. The purpose of this study is to uncover the factors associated with treatment delay (surgery, systemic therapy, or radiation therapy) in patients with CRC.

Method: We analyzed data from patients diagnosed with CRC between 2000 and 2022 at Queen's Medical Center in Honolulu, Hawaii. Patients initiating treatment ≥ 31 days after diagnosis were categorized as having a delayed treatment. Binary logistic regressions were used to identify predictors, adjusting for clinical and pathological factors.

Result: A total of 3192 patients were analyzed. 1128 (35.3%) patients experienced delayed treatment. On multivariable analysis, patients with older age demonstrated a progressively increased odds of delayed treatment, with odds ratio (OR) ranging from 1.35 (95% CI 1.02-1.79; p = 0.039) for patients aged 50-59 years to 1.81 (95% CI 1.32-2.47; p < 0.001) for those aged ≥ 80 years compared with patients under 50 years. Patients with Medicaid or being uninsured had significantly higher odds of delayed treatment compared with patients with private insurance (OR 1.54, 95% CI 1.25-1.89; p < 0.001). Stages 2 and 3 CRC were associated with lower odds of delay compared with stage 1. Tumor location was associated with delayed treatment. Compared with right-sided tumors, patients with rectal tumors (OR 3.16, 95% CI 2.56-3.90; p < 0.001) and left-sided colon cancer were significantly more likely to experience delayed treatment (OR 1.40, 95% CI 1.15-1.71; p < 0.001). Gender, race, and histopathology grading were not significantly associated with TTT ≥ 31 days.

Conclusion: Older age, having Medicaid or being uninsured, and having a rectal or left-sided tumor location were associated with delayed initiation of treatment in patients with colorectal cancer. Further research is needed to explore the underlying reasons for treatment delays in patients with these specific characteristics. Specific interventions, such as improving insurance access or addressing logistical challenges, may reduce time to initial treatment.