Factors associated with time to prostate cancer treatment initiation during the COVID-19 pandemic

Time from cancer diagnosis to treatment initiation (TTI) can influence clinical outcomes and is a measure of care quality. This study aimed to evaluate the associations between clinical, sociodemographic, and facility-level factors with treatment delays among patients with prostate cancer during the COVID-19 pandemic. We conducted a retrospective analysis of the National Cancer Database (NCDB) for prostate cancer cases diagnosed in 2020 and 2021. We assessed the associations between clinical factors, sociodemographic variables (age, race, ethnicity, sex, income, education, insurance), facility-related factors (facility type, geographic region), and TTI. Multivariable logistic regression was used to identify factors associated with prolonged TTI, defined as the top decile of days to treatment. We identified 160,863 patients, with a median TTI of 71 days (IQR: 43-107). The 90th percentile for TTI was 154 days. Compared to White race, Black (OR 1.39, 95% CI 1.33-1.45), Asian (OR 1.28, 95% CI 1.08-1.52), and Hispanic (OR 1.31, 95% CI 1.21-1.41) patients had significantly longer TTI. Treatment at academic (OR 1.84, 95% CI 1.70-2.00), network (OR 1.37, 95% CI 1.25-1.49), and comprehensive facilities (OR 1.16, 95% CI 1.07-1.26) was associated with longer TTI compared to community facilities. Lastly, private insurance was associated with shorter delays compared to uninsured individuals (OR 0.75, 95% CI 0.71-0.81). Sociodemographic disparities, including race, insurance status, and treatment facility, were associated with longer TTI among prostate cancer patients during the COVID-19 pandemic. These findings can guide efforts to improve timeliness of cancer care.