Treatment delay significantly increases mortality in colorectal cancer: a meta-analysis

Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted...

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Published in:	GeroScience Vol. 47; no. 3; pp. 5337 - 5353
Main Authors:	Ungvari, Zoltan, Fekete, Mónika, Fekete, János Tibor, Lehoczki, Andrea, Buda, Annamaria, Munkácsy, Gyöngyi, Varga, Péter, Ungvari, Anna, Győrffy, Balázs
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01.06.2025 Springer Nature B.V
Subjects:	Analysis Biomedical and Life Sciences Cancer Cancer therapies Cell Biology Chemotherapy Clinical medicine Colorectal cancer Colorectal carcinoma Colorectal Neoplasms - mortality Colorectal Neoplasms - therapy Complex patients Decision making Estimates Geriatrics/Gerontology Health care policy Humans Life Sciences Malignancy Medical treatment Meta-analysis Molecular Medicine Mortality Oncology Original Original Article Patients Radiation therapy Ratios Risk Statistical analysis Statistical significance Statistics Surgery Survival Time Factors Time-to-Treatment - statistics & numerical data Treatment Delay Cancer treatment access Colorectal cancer Referral pathways Multimorbidity Time-to-treatment benchmarks Treatment delay Healthcare disparities Telemedicine Diagnostic delays Cancer survival Healthcare inefficiencies Frailty Oncology care pathways Patient navigation Geriatric oncology
ISSN:	2509-2723, 2509-2715, 2509-2723
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Abstract	Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I 2 -statistics and publication bias evaluated using funnel plots and Egger’s test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12–39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08–1.16; 8 weeks, HR = 1.24; 95% CI, 1.16–1.34; 12 weeks, HR = 1.39; 95% CI, 1.25–1.55). In particular, incrementally higher hazard ratios were observed for all–cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09–1.18), 8 weeks (HR = 1.29; 95% CI, 1.20–1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31–1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98–1.18; 8 weeks, HR = 1.15; 95% CI, 0.95–1.39; 12 weeks, HR = 1.23; 95% CI, 0.93–1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates.
AbstractList	Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I -statistics and publication bias evaluated using funnel plots and Egger's test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12-39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08-1.16; 8 weeks, HR = 1.24; 95% CI, 1.16-1.34; 12 weeks, HR = 1.39; 95% CI, 1.25-1.55). In particular, incrementally higher hazard ratios were observed for all-cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09-1.18), 8 weeks (HR = 1.29; 95% CI, 1.20-1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31-1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98-1.18; 8 weeks, HR = 1.15; 95% CI, 0.95-1.39; 12 weeks, HR = 1.23; 95% CI, 0.93-1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates. Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I2-statistics and publication bias evaluated using funnel plots and Egger's test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12-39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08-1.16; 8 weeks, HR = 1.24; 95% CI, 1.16-1.34; 12 weeks, HR = 1.39; 95% CI, 1.25-1.55). In particular, incrementally higher hazard ratios were observed for all-cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09-1.18), 8 weeks (HR = 1.29; 95% CI, 1.20-1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31-1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98-1.18; 8 weeks, HR = 1.15; 95% CI, 0.95-1.39; 12 weeks, HR = 1.23; 95% CI, 0.93-1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates.Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I2-statistics and publication bias evaluated using funnel plots and Egger's test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12-39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08-1.16; 8 weeks, HR = 1.24; 95% CI, 1.16-1.34; 12 weeks, HR = 1.39; 95% CI, 1.25-1.55). In particular, incrementally higher hazard ratios were observed for all-cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09-1.18), 8 weeks (HR = 1.29; 95% CI, 1.20-1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31-1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98-1.18; 8 weeks, HR = 1.15; 95% CI, 0.95-1.39; 12 weeks, HR = 1.23; 95% CI, 0.93-1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates. Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I 2 -statistics and publication bias evaluated using funnel plots and Egger’s test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12–39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08–1.16; 8 weeks, HR = 1.24; 95% CI, 1.16–1.34; 12 weeks, HR = 1.39; 95% CI, 1.25–1.55). In particular, incrementally higher hazard ratios were observed for all–cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09–1.18), 8 weeks (HR = 1.29; 95% CI, 1.20–1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31–1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98–1.18; 8 weeks, HR = 1.15; 95% CI, 0.95–1.39; 12 weeks, HR = 1.23; 95% CI, 0.93–1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates. Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I2-statistics and publication bias evaluated using funnel plots and Egger’s test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12–39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08–1.16; 8 weeks, HR = 1.24; 95% CI, 1.16–1.34; 12 weeks, HR = 1.39; 95% CI, 1.25–1.55). In particular, incrementally higher hazard ratios were observed for all–cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09–1.18), 8 weeks (HR = 1.29; 95% CI, 1.20–1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31–1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98–1.18; 8 weeks, HR = 1.15; 95% CI, 0.95–1.39; 12 weeks, HR = 1.23; 95% CI, 0.93–1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates. Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I2-statistics and publication bias evaluated using funnel plots and Egger’s test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12–39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08–1.16; 8 weeks, HR = 1.24; 95% CI, 1.16–1.34; 12 weeks, HR = 1.39; 95% CI, 1.25–1.55). In particular, incrementally higher hazard ratios were observed for all–cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09–1.18), 8 weeks (HR = 1.29; 95% CI, 1.20–1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31–1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98–1.18; 8 weeks, HR = 1.15; 95% CI, 0.95–1.39; 12 weeks, HR = 1.23; 95% CI, 0.93–1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates. Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I 2 -statistics and publication bias evaluated using funnel plots and Egger’s test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12–39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08–1.16; 8 weeks, HR = 1.24; 95% CI, 1.16–1.34; 12 weeks, HR = 1.39; 95% CI, 1.25–1.55). In particular, incrementally higher hazard ratios were observed for all–cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09–1.18), 8 weeks (HR = 1.29; 95% CI, 1.20–1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31–1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98–1.18; 8 weeks, HR = 1.15; 95% CI, 0.95–1.39; 12 weeks, HR = 1.23; 95% CI, 0.93–1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates.
Author	Győrffy, Balázs Ungvari, Zoltan Varga, Péter Fekete, Mónika Ungvari, Anna Munkácsy, Gyöngyi Buda, Annamaria Fekete, János Tibor Lehoczki, Andrea
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Keywords	Cancer treatment access Colorectal cancer Referral pathways Multimorbidity Time-to-treatment benchmarks Treatment delay Healthcare disparities Telemedicine Diagnostic delays Cancer survival Healthcare inefficiencies Frailty Oncology care pathways Patient navigation Geriatric oncology
Language	English
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Snippet	Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and...
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SubjectTerms	Analysis Biomedical and Life Sciences Cancer Cancer therapies Cell Biology Chemotherapy Clinical medicine Colorectal cancer Colorectal carcinoma Colorectal Neoplasms - mortality Colorectal Neoplasms - therapy Complex patients Decision making Estimates Geriatrics/Gerontology Health care policy Humans Life Sciences Malignancy Medical treatment Meta-analysis Molecular Medicine Mortality Oncology Original Original Article Patients Radiation therapy Ratios Risk Statistical analysis Statistical significance Statistics Surgery Survival Time Factors Time-to-Treatment - statistics & numerical data Treatment Delay
Title	Treatment delay significantly increases mortality in colorectal cancer: a meta-analysis
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