In a retrospective, population-based, cross-sectional study reported in JAMA Oncology, Heslin et al found that treatment delay in early-onset colorectal cancer was associated with poorer overall survival.
Study Details
The study used Texas Cancer Registry data from patients diagnosed with colorectal cancer from January 2004 to December 2019. Patients were classified as having early-onset colorectal cancer (EOCRC), defined as diagnosis at age < 50 years, or average age–onset colorectal cancer (AOCRC), defined as diagnosis at age 50 years or older. The main outcomes were EOCRC status and treatment delays, defined as initiation of definitive therapy at more than 6 weeks after tissue diagnosis.
Key Findings
Among 112,672 patients with colorectal cancer included in the analysis, 12,079 (11%) had EOCRC and 100,593 (89%) had AOCRC. Mean age was 41.6 years in the EOCRC cohort and 68.2 years in the AOCRC cohort.
Among the patients, 63.6% were White, 20.7% were Hispanic, 12.9% were Black, and 2.8% were Asian/Pacific Islanders. Compared with patients in the AOCRC cohort, those with EOCRC were less likely to be White (53.2% vs 64.9%, P < .001) and more likely to be Hispanic (28.1% vs 19.9%, P < .001).
Median overall survival was not reached among patients with EOCRC vs 80 months among patients with AOCRC (hazard ratio [HR] = 0.56, 95% confidence interval [CI] = 0.56–0.60, P < .001). In multivariable analysis, higher Social Vulnerability Index (HR = 1.22, 95% CI = 1.19–1.26, P < .001) and treatment delays (HR = 1.29, 95% CI = 1.26–1.32, P < .001) were associated with poorer overall survival.
Median overall survival was not reached among patients with EOCRC with vs without treatment delay; however, treatment delay remained significant for poorer outcome (HR = 1.35, 95% CI = 1.32–1.38, P < .001). In analysis adjusting for demographic and clinical factors, language barriers were associated with treatment delay in EOCRC (odds ratio = 1.45, 95% CI = 1.18–1.79, P < .001).
The investigators concluded: “In this cross-sectional study, EOCRC was associated with improved [overall survival] compared with AOCRC; however, treatment delays were independently associated with worse survival among patients with EOCRC. Language barriers could be a potentially modifiable risk factor associated with delayed treatment and may provide an opportunity to improve timely care and outcomes in EOCRC.”
Alex C. Kim, MD, PhD, of the Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, is the corresponding author for the JAMA Oncology article.
DISCLOSURE: No external funding was reported for the study. For full disclosures of the study authors, visit jamanetwork.com.
