Social determinants in the delay of starting colorectal cancer treatment.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Colorectal Neoplasms*/therapy ; Colorectal Neoplasms*/epidemiology ; Colorectal Neoplasms*/diagnosis ; Time-to-Treatment*/statistics & numerical data ; Social Determinants of Health*/statistics & numerical data; Brazil/epidemiology ; Humans ; Male ; Female ; Middle Aged ; Aged ; Retrospective Studies ; Socioeconomic Factors ; Longitudinal Studies ; Adult ; Health Services Accessibility ; Aged, 80 and over ; Healthcare Disparities

Delayed access to colorectal cancer (CRC) treatment leads to disease progression, advanced stages at diagnosis, and reduced survival. In Brazil, Law 12.732/2012 mandates treatment initiation within 60 days of diagnosis; however, disparities persist. To assess compliance with the 60-day treatment initiation window for CRC in Brazil and its association with individual, socioeconomic, and healthcare system factors. We conducted a longitudinal observational retrospective cohort study using data from 65,582 CRC cases diagnosed between 2013 and 2019 in Brazil. Individual-level data were obtained from the Integrator of Hospital Cancer Registries, while socioeconomic and healthcare infrastructure data were extracted from national databases. A Multilevel Poisson Regression model with a random intercept was applied. Approximately forty-two percent of patients experienced treatment delays beyond 60 days, with significant variability among Federal Units (UFs). The highest delay rates were observed in Goiás (60.7%), Pará (60.6%), and Acre (58.4%). Factors associated with delayed treatment included younger age, non-white race, low educational level, rectal tumor location, referral through the Unified Health System (SUS), and receiving treatment outside the patient's municipality of residence. Social determinants significantly impact CRC treatment delays in Brazil, highlighting the need to strengthen healthcare policies to ensure equitable and timely access to cancer treatment, ultimately improving patient survival.
(Copyright: © 2026 Dantas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The authors declare no competing interests.

Prostate Int. 2020 Jun;8(2):49-54. (PMID: 32647640)
Clin Lymphoma Myeloma Leuk. 2023 Nov;23(11):e369-e378. (PMID: 37690903)
BMC Cancer. 2016 Aug 22;16:664. (PMID: 27549406)
Sci Rep. 2024 Apr 26;14(1):9667. (PMID: 38671078)
Am Soc Clin Oncol Educ Book. 2022 Apr;42:1-7. (PMID: 35427189)
J Surg Res. 2021 Mar;259:420-430. (PMID: 33092860)
Cien Saude Colet. 2018 Jun;23(6):1791-1798. (PMID: 29972487)
Cancer Med. 2023 Sep;12(17):18133-18152. (PMID: 37526041)
Healthcare (Basel). 2017 Jan 29;5(1):. (PMID: 28146046)
J Bras Pneumol. 2016 Jul-Aug;42(4):240. (PMID: 27832229)
Ann Epidemiol. 2018 May;28(5):316-321.e2. (PMID: 29678311)
JAMA. 2021 May 18;325(19):1965-1977. (PMID: 34003218)
Asian Pac J Cancer Prev. 2024 Aug 01;25(8):2813-2821. (PMID: 39205579)
Cien Saude Colet. 2025 Jun;30(6):e04542025. (PMID: 40561315)
Eur J Gastroenterol Hepatol. 2011 Nov;23(11):1056-63. (PMID: 21941190)
World J Gastrointest Oncol. 2022 Jan 15;14(1):230-241. (PMID: 35116113)
BMJ Open Gastroenterol. 2022 Nov;9(1):. (PMID: 36410773)
BMC Cancer. 2021 Jun 30;21(1):757. (PMID: 34187404)
CA Cancer J Clin. 2024 May-Jun;74(3):229-263. (PMID: 38572751)
Lancet Gastroenterol Hepatol. 2022 Mar;7(3):262-274. (PMID: 35090605)
Am J Prev Med. 2020 Apr;58(4):596-603. (PMID: 32008799)
Ann Epidemiol. 2017 Nov;27(11):731-738.e1. (PMID: 29173578)
Cien Saude Colet. 2022 Jul;27(7):2516. (PMID: 35730823)
AJR Am J Roentgenol. 2015 Jul;205(1):W42-55. (PMID: 26102418)
Sci Rep. 2021 Feb 1;11(1):2712. (PMID: 33526801)
Patient Educ Couns. 2005 Jun;57(3):280-5. (PMID: 15893209)
Obstet Gynecol. 2015 Apr;125(4):833-842. (PMID: 25751200)
Br J Cancer. 2015 Mar 31;112 Suppl 1:S92-107. (PMID: 25734382)
BMJ Open. 2019 Sep 30;9(9):e031421. (PMID: 31575579)
JAMA Surg. 2017 Jun 1;152(6):558-564. (PMID: 28273303)
Pol Przegl Chir. 2015 Sep;87(9):459-63. (PMID: 26812841)
PLoS One. 2022 Sep 12;17(9):e0273396. (PMID: 36094913)
Nat Rev Clin Oncol. 2022 Oct;19(10):656-673. (PMID: 36068272)
Cien Saude Colet. 2018 Jun;23(6):1707-1714. (PMID: 29972476)
J Natl Cancer Inst. 2002 Mar 6;94(5):334-57. (PMID: 11880473)
Am J Epidemiol. 2004 Apr 1;159(7):702-6. (PMID: 15033648)
BMJ Open. 2020 Oct 13;10(10):e040645. (PMID: 33051237)
BMJ. 2020 Nov 4;371:m4087. (PMID: 33148535)
CA Cancer J Clin. 2023 May-Jun;73(3):233-254. (PMID: 36856579)
BMC Palliat Care. 2014 Jul 07;13:34. (PMID: 25028571)
JAMA Netw Open. 2023 Aug 1;6(8):e2328712. (PMID: 37578796)
Int J Environ Res Public Health. 2022 Jun 28;19(13):. (PMID: 35805565)
Br J Cancer. 2012 Mar 27;106(7):1262-7. (PMID: 22415239)
Cancer Commun (Lond). 2019 Apr 29;39(1):22. (PMID: 31030667)
Cancer Epidemiol. 2019 Feb;58:184-192. (PMID: 30639877)
Oncotarget. 2017 May 30;8(22):36728-36742. (PMID: 27888636)
Ann Fam Med. 2019 Sep;17(5):386-389. (PMID: 31501198)
BMC Med Res Methodol. 2003 Oct 20;3:21. (PMID: 14567763)
Br J Soc Psychol. 1995 Mar;34 ( Pt 1):33-52. (PMID: 7735731)

Date Created: 20260108 Date Completed: 20260108 Latest Revision: 20260120

20260130

PMC12782427

10.1371/journal.pone.0338727

41505410