Impact of insurance-related disparities on delay in treatment initiation among colorectal cancer patients in an underserved community teaching hospital.

Abstract

e23382 Background: Timely treatment after colorectal cancer (CRC) diagnosis is critical, nationally therapy starts within 30–60 days. Patients in underserved communities, with public or no insurance, may experience delays. This study assessed insurance-related disparities in time to treatment initiation at a community teaching hospital. Methods: in a retrospective cohort study of CRC patients diagnosed in 2025,51 gastrointestinal malignancies identified, 21 were CRC, and 17 patients with available data were included. Patients were stratified into public/uninsured and private groups. Time to treatment initiation was recorded in days and categorized as ≤30, 30–60, and > 60 days. Continuous delays were compared using the Mann–Whitney U test, and delays > 60 days using Fisher’s exact test in GraphPad Prism 10 (p < 0.05). Results: Among 17 colorectal cancer patients, 10 were publicly insured/uninsured and 7 had private insurance. The cohort was 52.9% female, and 58.8% had advanced-stage disease (stage III–IV). Median time to treatment initiation was longer among publicly insured/uninsured patients compared with privately insured patients (72.5 vs 18.0 days; Mann–Whitney U = 16, p = 0.067). Delays exceeding 60 days occurred in 60% of publicly insured/uninsured patients versus 42.9% of privately insured patients (odds ratio [OR] 2.0, 95% CI 0.28–11.2; Fisher’s exact p = 0.64). Conclusions: Public insurance and lack of insurance were associated with a four-fold longer time to treatment initiation in colorectal cancer patients in Woonsocket ,RI community hospital, with publicly insured/uninsured patients exceeding national average. Although older age and advanced disease may contribute to delays due to diagnostic workup and care coordination, the consistent magnitude of delay observed suggests that insurance status remains an important independent factor .system-level interventions are needed to address insurance-related barriers and improve equity in oncologic care. Characteristics. number age at diagnosis sex cancer Rectal/Colon insurance medicare/private/uninsured date of diagnosis date of first treatment surgery chemort Tx type <30 30-60 >60days stage 1 83 m R M 5/30/25 8/26/25 Chem 88 days stage 4 2 66 f R M 10/1/25 10-Nov chem 40 stage 2 3 67 f C M 3/5/25 4/8/25 chemo 34 stage 4 4 77 m C M 9/5/25 11/21/25 Sur 77 stage 2 5 76 m C P 9/26/25 10/14/25 Chem 18 days stage3 6 85 f C P Nov-20 nov2020 Sur 7days stage2 7 83 m C M 6/4/25 8/27/25 rt 84 days stage 3 8 42 m R U 11/18/25 1/25/26 Chem 68 days stage 3 9 71 m R P 4/22/25 4/22/25 Sur 7 days stage1 10 69 m R M 4/30/25 7/20/25 cmo 90 days stage 4 11 83 f C M 7/23/25 8/27/25 Sur 35 days stage2 12 52 f C P 23-Sep 8-Dec Sur 76 days stage2 13 55 f C M 03/0802025 6/5/25 CMO 89 days stage 4 14 74 f C M 11/10/25 11/21/25 Sur 11 days stage 2 15 82 f C P 3/25/25 4/1/25 Sur 7 days stage2 16 70 m C P 5/21/25 8/11/25 Sur 82 days stage3 17 75 f R P 6/26/25 8/29/25 rt 64days stage 4