Colorectal Cancer Treatment Delay Thresholds and Metastasis Risk

Are delays in time-to-treatment initiation (TTI) associated with increased metastatic progression risk in patients with newly diagnosed nonmetastatic colorectal cancer (CRC), and do these risks differ across treatment pathways?In this cohort study of 11 927 insured US patients with nonmetastatic CRC, treatment delays were associated with higher 3-year metastasis risk, with thresholds varying by treatment pathway. Even modest delays of 4 days or more were associated with higher metastatic risk in patients receiving surgery and adjuvant chemotherapy. Conversely, for surgery-only cases, only prolonged postponements (223 days or longer) indicated elevated risk, although this correlation lacked statistical significance.These results suggest that pathway-specific thresholds for treatment initiation may be more effective than a single universal threshold in improving outcomes, promoting timely, cost-effective CRC care, and guiding clinical practice and performance benchmarks.

Corresponding Author: Chi M. Nguyen, PhD, Department of Biostatistics cmnguyen@iu.edu).

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