Time to treatment initiation among patients with colorectal cancer and limited English proficiency.

Abstract

222 Background: Colorectal cancer is a leading cause of cancer-related mortality in the US. Over 25 million people in the US have limited English proficiency (LEP), a population known to experience worse cancer care outcomes. LEP, defined as speaking English "less than very well," is associated with disparities in cancer outcomes and may contribute to delays in diagnosis and treatment. However, the role of English proficiency on time to treatment initiation (TTI) in colorectal cancer and where these delays occur along the diagnostic-to-treatment pathway remains understudied. Methods: We conducted a retrospective cohort study using a single-institution database. Sociodemographic and clinical data were abstracted from medical records of adult patients (≥18 years) diagnosed with colorectal cancer between 2013 and 2025. Using Wilcoxon rank-sum tests, we examined whether patients with LEP experienced longer TTI compared to their English-proficient (EP) counterparts and evaluated where along the diagnostic-to-treatment pathway these delays occurred. Results: Among 5,613 patients with newly diagnosed colorectal cancer, the median age at diagnosis was 66 years. Most patients were male (n=2,925, 52%), non-Hispanic White (n=4,272, 81%), and insured through Medicare (n=2,926, 52%). Overall, 4,404 (79%) patients were treated with curative intent, 1,204 (21%) were treated with palliative intent, 5,281 (94%) were EP, and 332 (6%) had LEP. LEP patients had a longer median TTI compared with EP patients (31 days vs 26 days), although this difference was not statistically significant ( p=0.07 ). Among patients treated with curative intent, LEP patients experienced a significantly longer median time from diagnosis to first oncology visit compared with EP patients (30 days vs 24 days; p<0.05 ). LEP patients also had a longer median time from diagnosis to initiation of neoadjuvant therapy (37 days vs 27 days, p =0.004 ) and to post-surgical oncology follow-up (77 days vs 59 days, p=0.04 ). Conclusions: We found that LEP patients experienced delays at several points along the diagnostic-to-treatment pathway, including time from diagnosis to first oncology visit, initiation of neoadjuvant therapy, and post-surgical oncology follow-up. Understanding where these delays in TTI occur along the diagnostic-to-treatment pathway is vital to inform interventions to improve language access and ultimately reduce disparities in care among this vulnerable population. Disparities along the diagnostic-to-treatment pathway in patients with curative-intent colorectal cancer. EP (N = 4,155)Median (Q1, Q3) LEP (N = 249)Median (Q1, Q3) p-value Dx to First Oncology Visit 24 (11, 55) 30 (14, 73) < 0.05 Dx to Initiation of Neoadjuvant Therapy 27 (17, 42) 37 (25, 59) 0.004 Dx to Surgery 28 (5, 65) 34 (3, 102) 0.2 Dx to Post-Surgical Oncology Visit 59 (34, 150) 77 (38, 174) 0.04 Dx to Initiation of Adjuvant Therapy 88 (53, 204) 123 (53, 257) 0.2