Determinants Of Late-Stage Diagnosis Of Colorectal Cancer Among Adult Colorectal Cancer Patients At Tertiary Hospitals, Addis Ababa, Ethiopia, 2025

Abstract

Background: Colorectal cancer is the third most common cancer and the second most causes of cancer related deaths in both sexes worldwide. Worldwide, about 20-25% of newly diagnosed colorectal cancers have late/ advanced disease at presentation and 5-year survival is about 13%. In Ethiopia, it is the most common cancer cases in men and the overall 5-year survival rate is about 26.6% and it is largely influenced by the advanced cancer stage at presentation and delays in the administration of therapy. There is a huge gap in addressing the determinants for late-stage diagnosis of Colorectal cancer in Ethiopia. Objectives: The objective of this study was to identify the determinants of late-stage diagnosis of colorectal cancer among adult colorectal cancer patients at tertiary hospitals, Addis Ababa, Ethiopia, 2025 Methods: An institution based unmatched case control study was conducted from March 15 to May 20, 2025. The study included 118 late-stage cases, selected using systematic random sampling and consecutively sampled 236 early-stage controls of adult colorectal cancer patients treated at tertiary hospitals in Ethiopia. Data were collected using interviewer administered structured questionnaire and patients’ digital record for clinicopathologic information. Collected data were exported into SPSS version 27. Data distribution, model fitness and multicollinearity were checked. First, bivariable binary logistic regression was analyzed and variables with P value <0.25 were further analyzed using multivariable binary logistic regression and odds ratio and its 95% confidence interval was used to measure the association of independent variables with outcome variable. P value <0.05 was deemed statistically significant. Results: In this study, 354 participants were interviewed, 118 cases and 236 controls with 92.9% response rate. Age <50 years (AOR=2.032; 95% CI:1.173-3.520), monthly income <3000ETB(AOR=0.524; 95% CI:0.297-0.925), lack of chronic medical illness(AOR=2.62; 95% CI:1.315-5.231), lack of community based health insurance(AOR=0.461; 95% CI:0.265-0.801), failure to recognize symptoms as a serious(AOR=0.466; 95% CI:0.277-0.783), absence of presumptive colorectal cancer symptoms(AOR=10.83; 95% CI:3.424-34.276), well differentiated histologic grade(AOR=0.202; 95% CI:0.105-0.391)), moderately differentiated histologic grade(AOR=0.371; 95% CI:0.187-0.734) and being diagnosed at first visit(AOR=0.507; 95% CI:0.271-0.950) were more likely associated with late-stage diagnosis of colorectal cancer. Conclusion: In this study, younger age at diagnosis, lack of at least one chronic medical illness lower monthly income, lack of community-based health insurance, absence of presumptive CRC symptoms, failure to recognize seriousness of CRC symptoms, missed diagnosis at first visit and more differentiated histology were determinants of late-stage diagnosis of CRC. Younger patients with early warning signs of CRC should visit the health care timely and Ethiopia should adopt early initiation of CRC screening