Prevalence and factors associated with treatment delay among colorectal cancer patients at MNRH and UCI- a cross sectional study

Abstract

Background: Colorectal cancer (CRC) is an important cause of morbidity and mortality in Uganda. Timely treatment initiation is critical for outcomes, yet delays are common. This study assessed treatment delays and associated factors among CRC patients at Mulago National Referral Hospital (MNRH) and the Uganda Cancer Institute (UCI). Objective: To determine the diagnosis to treatment interval (DTI), prevalence of treatment delay, and the associated patient and clinicopathologic factors among CRC patients. Methods: A hospital-based cross-sectional study was conducted among 67 patients with histologically confirmed CRC between December 2024 and May 2025. Treatment delay was defined as >31 days between histological diagnosis and first oncologic treatment. Data were collected through interviews and record review. Descriptive statistics summarized demographics and clinical characteristics. Bivariate Poisson regression with robust variance estimation identified factors associated with delay; variables with p<0.20 entered a multivariable model. Prevalence ratios (PRs) with 95% confidence intervals (CIs) were reported. IRB approval was obtained (Ref: Mak-SOMREC-2024-1048). Results: The mean age was 50.5 years (SD: 15.1); 55.2% were female, and 71.6% (n=48) had advanced-stage disease (Stage III/IV). The median DTI was 53 days (IQR: 25–95), with 70.1% (n=47) experiencing delays. Median DTI by treatment: chemotherapy 53 days, radiotherapy 79 days, surgery 14 days. While late-stage disease, comorbidities, and long travel distances showed trends toward delay, only socioeconomic status (SES) was significant. Patients with high SES vulnerability (score ≥4) had 34% higher prevalence of delay (PR=1.34, 95% CI: 1.01–1.78, p=0.042). Conclusion: Most CRC patients experienced treatment delays which were widespread and occurred across all categories; regardless of distance to the treatment facility, clinical status, or disease severity. Socioeconomic disadvantage was the only independent predictor, underscoring the role of structural and financial barriers in timely care. Targeted, context specific interventions are urgently needed to reduce delays and improve outcomes.