Delayed Colorectal Cancer Treatment Tied to Worse Outcomes in Two Studies

Two recent studies examined the impact of treatment delays on patients with colorectal cancer (CRC). One study, published in JAMA Oncology, found that treatment delays of more than six weeks had a significant negative impact on overall survival, and a study published in Diseases of the Colon & Rectum found that patients with high socioecological comorbidity burden delay initiating treatment for CRC.

The JAMA Oncology study examined medical data and outcomes from 112,672 patients with colorectal cancer. The researchers classified early-onset colorectal cancer (EOCRC) as those diagnosed before age 50, and average-onset colorectal cancer (AOCRC) as those diagnosed at 50 years or older. Delayed treatment constituted cases where therapy began more than six weeks after diagnosis. Among all the colorectal cancer patients, only 11% (12,079) had EOCRC, while 89% (100,593) had AOCRC. The researchers reported the average age of EOCRC and AOCRC patients as 41.6 and 68.2 years, respectively. On average, AOCRC patients survived 80 months after diagnosis. The average overall survival for EOCRC patients had not been reached at the time of publication, indicating that more than half of this cohort remained alive. Treatment delays of more than six weeks had a significant negative impact on overall survival for those with AOCRC. While average survival for EOCRC patients had not been reached among those with or without treatment delays, the authors report that treatment delays remained significant. In particular, patients experiencing a language barrier with the healthcare team had the most significant delays to treatment.

Separately, a study published in Diseases of the Colon & Rectum investigated the importance of patient-level socioecological determinants of health (SEDOH) on CRC outcomes. Prior studies identified that area-level socioecological determinants of health prolonged time to treatment initiation, reduced receipt of guideline-directed care, and negatively affected CRC outcomes. Patients (N=145) with known or suspected primary colorectal adenocarcinoma scheduled to undergo curative-intent resection at 3 hospitals in the United States between 2023 and 2025 were evaluated for time from diagnosis to operation on the basis of socioecological comorbidity. A total of 20 features were included in the outcome of socioecological comorbidity, which was assessed using the Socioecological Determinants of Health-88 (SEDOH-88) survey. High socioecological comorbidity was defined as a SEDOH-88 score in the 75th percentile or higher. The median time from diagnosis to treatment initiation was 49 (IQR, 36-62) days. Patients with high burden had a median time to treatment of 55.5 (IQR, 39.5-85.5) days compared with 47.5 (IQR, 35.8-62) days for those without high burden (P =.14). Patients with high socioecological comorbidity who were referred from outside the health system had a longer time to treatment initiation than those without high socioecological comorbidity (median, 115 vs 46 days; P =.002). High socioecological comorbidity associated with a longer time to treatment initiation (adjusted hazard ratio [aHR], 0.54; 95% CI, 0.33-0.89; P =.016), with a significant interaction with referral status (aHR, 0.17; 95% CI, 0.05-0.52; P =.002). The study investigators concluded, 'Among patients with colorectal cancer, patient-level high socioecological comorbidity was associated with delayed initiation of cancer treatment. These findings support integrating socioecological comorbidity screening into clinical care pathways, and future work is needed to test interventions targeting socioecological barriers to timely colorectal cancer care.'