Prevalence and determinants of late time to treatment initiation among colorectal cancer patients in the Amhara Region, Ethiopia

Abstract

Introduction: timely initiation of colorectal cancer (CRC) treatment is essential for optimal patient outcomes. However, delays remain a major challenge in Ethiopia. This study aimed to assess the prevalence and determinants of late time to treatment initiation among CRC patients in oncology centers of the Amhara Region, Ethiopia. Methods: a multicenter cross-sectional study was conducted from March 30 to April 20, 2024, at Dessie, Gondar, and Felege Hiwot Oncology Centers. Data were extracted from the medical records of CRC patients diagnosed between July 1, 2018, and June 30, 2023. Bivariable and multivariable logistic regression analyses were performed. A p-value <0.05 was considered statistically significant. Results: among 464 CRC patients, 260 (56.0%; 95% CI: 51.4-60.0%) experienced delayed treatment initiation (>60 days after diagnosis). Distance from the treatment center (>81 km; AOR=3.54, 95% CI: 2.23-5.60), lack of health insurance (AOR=1.83, 95% CI: 1.20-2.78), good performance status (AOR=2.55, 95% CI: 1.53-4.24), and non-metastatic disease (AOR=1.67, 95% CI: 1.08-2.58) were significantly associated with treatment delay. Conclusion: late treatment initiation is common among CRC patients in the Amhara region. Geographic distance, lack of insurance, and certain clinical factors contribute to this delay. Efforts to decentralize oncology care and strengthen financial protection are essential to improve timely access to treatment.