Background: Colorectal cancer (CRC) is an emerging public health concern in Ethiopia, with an estimated 3,347 new cases reported in 2022. This local burden reflects a global rise, with CRC projected to reach 2.2 million new cases and 1.1 million deaths worldwide by 2030. Delayed initiation of treatment contributes to disease progression, increased complications and higher healthcare costs. Despite this, limited local evidence exists regarding factors contributing to treatment delays. This study aimed to assess how patient-related, health system and socioeconomic factors influence delayed treatment initiation among CRC patients in a resource-limited setting.
Objective: To identify determinants of delayed treatment initiation among CRC patients at Hawassa University Comprehensive Specialized Hospital (HUCSH), Sidama Regional State, Southern Ethiopia.
Methods: A hospital-based retrospective cohort study was conducted at HUCSH. Data were collected in August 2025 through retrospective review of medical records of CRC patients managed at HUCSH between 2017 and 2025. The data were analysed using SPSS version 27.0. Patients were categorised as delayed or not delayed based on treatment initiation time. Logistic regression analysis was used to determine independent predictors of treatment delay.
Results: The prevalence of delayed treatment initiation was 77.2% (95% CI: 73.3–81.1). Significant predictors of delay included being married (adjusted odds ratio [AOR] = 3.71), rural residence (AOR = 2.11) and lack of health insurance (AOR = 2.41). Clinical factors such as rectal tumour site (AOR = 8.00) and elective surgery (AOR = 21.16) were also associated with increased delays. Patients with tumour nodes metastasis stage III disease were less likely to experience delays (AOR = 0.91), possibly due to clinical prioritisation.
Conclusion: Delayed treatment initiation among CRC patients at HUCSH is highly prevalent and influenced by demographic, socioeconomic and clinical factors. The findings highlight the need to expand health insurance coverage, improve access for rural populations and optimise surgical scheduling. Addressing these barriers is essential to reduce treatment delays and improve outcomes for CRC patients in Ethiopia.
