Determinants of Treatment Delay and Its Impact on Clinical Outcomes Among Cancer Patients

Open Access

Abstract

Background: Timely initiation of cancer treatment is essential for disease control and optimal clinical outcomes. In resource-constrained settings, delays may arise from socioeconomic disadvantage, geographical barriers, fragmented referral pathways, and repeated healthcare visits. Aim of the study: To determine the major factors associated with treatment delay and evaluate its association with adverse clinical outcomes among cancer patients. Methods & Materials: This hospital-based observational study included 250 adult patients with confirmed malignancy who were newly diagnosed or awaiting initiation of definitive cancer-directed treatment. Sociodemographic, clinical, healthcare-seeking, diagnostic, and treatment-related information was collected through structured interviews and medical-record review. Treatment delay was defined as >30 days from symptom onset to initiation of definitive treatment. Associations were assessed using chi-square/Fisher's exact tests, followed by multivariable logistic regression to identify independent determinants of treatment delay and adverse clinical outcomes. Results: The mean age was 52.8±13.7 years, and 63.2% of patients were from rural areas. Overall treatment delay >30 days occurred in 58.8%, with a mean symptom-onset-to-treatment interval of 120.1±54.8 days. Rural residence, lower educational attainment, household income <20,000 BDT, distance >100 km, initial consultation outside a specialist centre, and ≥3 healthcare visits before diagnosis were independently associated with treatment delay. Patients with delayed treatment had significantly higher proportions of advanced disease, progressive metastasis, poor ECOG performance status, emergency admission, treatment interruption, and incomplete planned treatment. Treatment delay >30 days remained independently associated with adverse clinical outcomes (aOR 2.67, 95% CI 1.55-4.61; p<0.001), alongside stage III/IV disease, ECOG ≥2, and metastatic disease. Conclusion: Treatment delay was common and was strongly associated with socioeconomic, geographical, and healthcare-pathway barriers. Delayed treatment was independently associated with adverse clinical outcomes, emphasizing the need for earlier referral, coordinated diagnostic pathways, and equitable access to timely cancer treatment.