Regional inequities in colon cancer surgical care: Patterns of treatment delay across U.S. facilities

Objectives

Timely surgical resection is critical for optimal survival in colon cancer, yet delays remain common. Persistent inequities in access to surgery may contribute to these delays, but how these disparities vary across U.S. regions and over time is not well understood. We aimed to assess regional variation in surgical treatment delays (>8 weeks from diagnosis) for Stage I–III colon cancer in the United States and determine how racial, insurance, and geographic disparities manifest and evolve across regions from 2004 to 2021.

Study design

Retrospective cohort study.

Methods

We analyzed patients treated at Commission on Cancer-accredited facilities across the nine U.S. Census Divisions using data from the National Cancer Database (2004–2021). Adults diagnosed with Stage I-III colon cancer who underwent surgical resection as first-course treatment and had complete demographic, clinical, and facility data available were included. The primary outcome was surgical delay >8 weeks from diagnosis to surgery. Multivariable logistic regression models were used to assess factors associated with surgical delay and interactions to evaluate variation by U.S. Census Division and over time. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated, with adjusted predicted probabilities for disparities by region and year.

Results

Of 664,312 patients, 48,579 (7.3 %) had surgical delays >8 weeks, increasing from 4.5 % in 2004 to 12.2 % in 2021 (aOR 2.77; 95 % CI, 2.61–2.94). Compared with New England, delays were less common in East South Central (aOR 0.60) and West North Central (aOR 0.67) regions. Higher odds occurred among Black (aOR 1.34), American Indian/Alaska Native/Aleut/Eskimo (aOR 1.24), Asian American (aOR 1.06), Medicaid (aOR 1.19), and Other/Unknown/Government-insured patients (aOR 1.16). Disparities varied by region (p < 0.001), with the largest Black–White gap in West North Central (9.0 % vs 4.9 %) and the smallest in East South Central (5.2 % vs 4.6 %). The Pacific had the steepest delay increase over time.

Conclusions

From 2004 to 2021, colon cancer surgery delays rose nationwide, with substantial regional variation in racial, insurance, and geographic disparities. Targeted strategies are needed to address systemic and regional barriers.