Tanariyakul Manasawee, Wannaphut Chalothorn, Takahashi Toshiaki, Nguyen Edward, Acoba Jared
University of Hawai'i at Manoa, Honolulu, HI, USA.
University of Hawai'i Cancer Center, Honolulu, HI, USA.
J Gastrointest Cancer. 2025 Jul 19;56(1):160. doi: 10.1007/s12029-025-01279-9.
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.
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.
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.
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.
结直肠癌（CRC）是美国癌症死亡的第二大常见原因。许多可改变的因素会影响预后，包括但不限于饮食、吸烟、饮酒以及诊断至初始治疗的时间（TTT）。研究发现，在新冠疫情期间手术延迟超过1个月且TTT超过31天的患者死亡风险增加。本研究的目的是揭示结直肠癌患者治疗延迟（手术、全身治疗或放射治疗）的相关因素。
我们分析了2000年至2022年期间在夏威夷檀香山女王医疗中心被诊断为结直肠癌的患者的数据。诊断后≥31天开始治疗的患者被归类为治疗延迟。采用二元逻辑回归来识别预测因素，并对临床和病理因素进行调整。
共分析了3192例患者。1128例（35.3%）患者经历了治疗延迟。在多变量分析中，年龄较大的患者治疗延迟的几率逐渐增加，与50岁以下的患者相比，50 - 59岁患者的优势比（OR）为1.35（95%CI 1.02 - 1.79；p = 0.039），≥80岁患者的OR为1.81（95%CI 1.32 - 2.47；p < 0.001）。与拥有私人保险的患者相比，参加医疗补助计划或未参保的患者治疗延迟的几率显著更高（OR 1.54，95%CI 1.25 - 1.89；p < 0.001）。与1期相比，2期和3期结直肠癌延迟治疗的几率较低。肿瘤位置与治疗延迟有关。与右侧肿瘤相比，直肠肿瘤患者（OR 3.16，95%CI 2.56 - 3.90；p < 0.001）和左侧结肠癌患者更有可能经历治疗延迟（OR 1.40，95%CI 1.15 - 1.71；p < 0.001）。性别、种族和组织病理学分级与TTT≥31天无显著关联。
年龄较大、参加医疗补助计划或未参保以及肿瘤位于直肠或左侧与结直肠癌患者治疗开始延迟有关。需要进一步研究探索具有这些特定特征患者治疗延迟的潜在原因。特定的干预措施，如改善保险获取或解决后勤挑战，可能会减少至初始治疗的时间。
