Delayed treatment initiation is associated with worse survival in screening-detected patients with upper gastrointestinal cancer in rural China: a 10-year cohort study

Abstract

Background Time to treatment initiation (TTI) following cancer detection is a critical component of effective cancer control. In low-resource and rural settings, delays in TTI often reflect health system constraints and may undermine the survival benefits of screening programmes. However, evidence on the association between TTI and long-term survival among screening-positive patients with upper gastrointestinal cancer (UGC) in China is unknown. Methods This retrospective cohort study included 265 screening-positive UGC patients identified from a population-based screening programme conducted between 2014 and 2015 in rural China (total screened population = 13,255). Time to treatment initiation was defined as the interval between confirmed diagnosis and initiation of treatment. Patients were categorised into ≤30 days, >30 days, and untreated groups. The primary outcome was 10-year overall survival (OS). Cox proportional hazards models were used to estimate hazard ratios (HRs), adjusting for demographic, socioeconomic, and clinical variables. Results The median TTI was 55 days. Patients with TTI≤30 days had significantly higher 10-year OS (90.39%) compared with those with TTI>30 days and untreated patients. After adjustment, delayed treatment (>30 days) was associated with worse OS (HR = 2.50; 95% CI = 1.29–4.82) and cancer-specific survival (HR = 2.41; 95% CI = 1.21–4.79). Factors associated with delayed treatment included male, non-normal BMI, and earlier-stage lesions, indicating socioeconomic and structural barriers to timely treatment. Conclusions Delays in treatment initiation represent a critical health system bottleneck that significantly compromises long-term survival among screening-detected UGC patients. A TTI threshold of 30 days may serve as a pragmatic quality-of-care indicator. Strengthening linkage-to-care pathways and addressing socioeconomic barriers are essential to maximise the effectiveness of cancer screening programmes in low-resource settings.