EARLY onset colorectal cancer treatment timeliness varies by sex, race, and geography, with patients in urban areas showing slightly delayed treatment initiation compared with those in rural settings.
Treatment Timeliness in Colorectal Cancer
A retrospective cross-sectional analysis of 79,090 patients with early onset colorectal cancer examined time to treatment across 30-, 60-, and 90-day intervals following diagnosis. Data were drawn from 2006–2020 incidence records, with treatment initiation censored if not started.
The mean time to treatment was 20.0 days, though variation emerged across geographic settings. Patients in mostly rural areas had the shortest mean time to treatment at 17.8 days, while those in entirely urban areas experienced the longest delays at 20.7 days.
These findings challenge assumptions that rural populations consistently face greater barriers to timely care, instead suggesting nuanced differences in treatment pathways.
Demographic Disparities in Treatment Initiation
Differences in treatment timeliness were also observed across demographic groups. Male patients were more frequently located in rural areas, while female patients were more commonly found in urban settings. Racially and ethnically minoritised populations predominantly resided in urban areas.
Adjusted analyses using Cox proportional hazards models showed that male patients in urban areas were approximately 5% less likely to initiate treatment within the studied intervals. Similarly, Asian or Pacific Islander, Black, and Hispanic patients in urban settings were less likely to begin treatment within 90 days compared with reference groups.
Reported associations included: Asian or Pacific Islander patients (hazard ratio: 0.96; 95% CI: 0.93–0.99; p=0.01), Black patients (hazard ratio: 0.95; 95% CI: 0.92–0.98; p=0.001), and Hispanic patients (hazard ratio: 0.93; 95% CI: 0.91–0.95; p<0.001). Similar trends were observed at 30 and 60 days.
Modest Effect Sizes Highlight Subtle Gaps
Although several findings reached statistical significance, effect sizes were small, with hazard ratios close to 1.00. This indicates that absolute differences in treatment timing were modest despite consistent patterns across subgroups.
The study addressed missing data through multiple imputation, accounting for 11,312 patients, and applied false discovery rate adjustments to control for multiple comparisons.
Overall, these data underscore persistent, albeit modest, disparities in early onset colorectal cancer treatment timeliness. The findings highlight the importance of examining intersecting demographic and geographic factors to better understand and address delays in cancer care delivery.
Reference
Tsai MH et al. Geographic, racial, and sex disparities in time to treatment for early-onset colorectal cancer. JAMA Netw Open. 2026;9;(3):e261980.
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