Patient-Level Socioecological Comorbidities and Time to Initiation of Curative-Intent Treatment for Colorectal Cancer

BACKGROUND: Socioecological comorbidity is associated with suboptimal cancer care. Prior studies are limited to area-level rather than patient-level data. OBJECTIVE: This study aimed to evaluate whether patient-level socioecological comorbidity is associated with delays in multimodal treatment for colorectal cancer. DESIGN: This is a prospective cohort study. Study subjects completed a comprehensive survey across 20 socioecological domains. High socioecological comorbidity was defined as a composite score at or above the 75th percentile. SETTINGS: Single-center study across 3 hospitals within a statewide healthcare system. PATIENTS: Adult patients with known or suspected primary colorectal adenocarcinoma across all stages who underwent curative-intent treatment from June 2023 to December 2025. MAIN OUTCOME MEASURES: Time from cancer diagnosis to treatment initiation. RESULTS: Of the 145 patients, the median age at cancer diagnosis was 65 years, 50.3% were female, and 6.9% self-identified as Black. Kaplan-Meier analysis revealed a longer duration of untreated status among patients with high socioecological comorbidity (p = 0.02). On adjusted Cox proportional hazards regression, high socioecological comorbidity was associated with a significantly longer time to treatment initiation (HR 0.54, 95% CI: 0.33-0.89; p = 0.016). Patients with high socioecological comorbidity who were referred from outside the health system experienced substantially longer delays to treatment initiation than those with low comorbidity (115 days [IQR 84-154.3] vs. 46 days [IQR 38.3-61.5]; p = 0.002). Area-level deprivation indices were not significantly associated with time to treatment initiation. LIMITATIONS: Socioecological comorbidity was treated as a non-time-varying exposure. CONCLUSIONS: Patients with high socioecological comorbidity were half as likely to have initiated colorectal cancer treatment compared to those with low comorbidity, particularly among patients referred from outside the health system. Area-level indices failed to capture these delays. These findings support perioperative screening at the individual level. Future research should evaluate targeted interventions to reduce barriers to timely cancer care. See Video Abstract.