ABSTRACT

Background: Colorectal cancer (CRC) is a prevalent cancer in Ethiopia, with an estimated 3,347 new cases in 2022. The disease is projected to rise to 2.2 million new cases and 1.1 million deaths by 2030. Delays in treatment can lead to disease progression, complications, and increased healthcare costs. This study aimed to address the gap in availability of local evidence on delayed treatment initiation among CRC patients, by examining how patient-related, health system, and socioeconomic barriers interact in resource-limited settings.

Objective: This study aims to identify the determinants of delayed treatment initiation among patients with CRC at Hawassa University Comprehensive Specialized Hospital, Sidama Regional state, Southern Ethiopia

Methods: A retrospective cohort study was conducted at HUCSH, analyzing the time todalliance of treatment initiation for colorectal cancer patients diagnosed and treated. The study included 469 participants, covering the period from May 1, 2017 to April 30, 2025. The analysis focused on baseline characteristics and dependent variables, categorizing patients as delayed or not delayed. The study used logistic regression to determine the net effect of each explicatory variable on treatment initiation time.

Result: Of the 469 CRC patients, the overall incidence of delayed treatment initiation was 77.2% (95% CI, 73.37, 81.00) with median time of 130 days. In this study different predictors were identified: married individuals (AOR=3.71), rural residents (AOR=2.11), and lack of health insurance was associated with increased risk (AOR=2.41). Additionally, rectal tumor site (AOR=8.00), TNM stage III disease (AOR=0.91), and elective surgery (AOR=21.16) were independent predictors of treatment initiation delay of ≥60 days.

Conclusion: This study revealed a high rate of delayed treatment initiation among colorectal

cancer patients, driven by factors such as marital status, rural residence, lack of health insurance, rectal tumor site, and elective surgery. Interestingly, Stage III patients were less likely to face delays, possibly due to prioritization. The unexpected delay among married individuals 8underscores the influence of local context. Overall, the findings remind us expand insurance coverage, health access, and optimize surgical scheduling to reduce delays among CRC patients.

Keywords: Colorectal Cancer, Treatment Delay, Time to Treatment Initiation, RetrospectiveCohort Study, Sidama Region

Deresse Daka