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

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.