Disparities in diagnosis and access to care in patients with young-onset rectal cancers in northeast Ohio.

Rohan Patel Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH info_outline Rohan Patel, Alex Price, Emily Steinhagen-Golbig, Madison Conces, Jennifer Anne Dorth, Jennifer Miller-Ocuin, J. Eva Selfridge, Amr Mohamed, Sakti Chakrabarti, Amit Mahipal, David L Bajor, Lauren E. Henke, Melissa Amy Lumish

Authors Rohan Patel Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH info_outline Rohan Patel, Alex Price, Emily Steinhagen-Golbig, Madison Conces, Jennifer Anne Dorth, Jennifer Miller-Ocuin, J. Eva Selfridge, Amr Mohamed, Sakti Chakrabarti, Amit Mahipal, David L Bajor, Lauren E. Henke, Melissa Amy Lumish Organizations Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, Division of Colorectal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, Department of Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH Abstract Disclosures Research Funding No funding sources reported Background: The rising incidence of young-onset colorectal cancers (YO-CRC) in individuals < 50 years old is alarming. Despite the updated USPSTF recommended age for CRC screening ( < 45) in 2021, disparities in receiving proper care for YO-CRC remained largely under addressed. We sought to identify modifiable disparities to be addressed with future interventions for patients with YO-rectal cancer (YO-RC). Methods: We analyzed a cohort of patients with newly diagnosed YO-RC from 2001 to 2023 at a large academic center in Northeast Ohio. Demographic data included sex, race, age, smoking status, and poverty index. A retrospective chart review was completed to assess diagnosis date and time from symptom onset to diagnosis. Access to guideline-concordant care was assessed via clinic visits with specialty providers in medical oncology, radiation oncology, colorectal surgery, genetics, and onco-fertility. Chi-square testing and Cox regression modeling was used for statistical analyses. Results: We identified 83 patients with YO-RC, 52% female (n = 43) and 48% male (n = 40), of which 76% were White (n = 63), 21% Black (n = 17), 2% Hispanic (n = 2), and 1% Asian (n = 1). Median age at diagnosis was 44 years (IQR[39-49]). Non-White (NW) patients had a greater delay from symptom onset to diagnosis compared to White (W) patients, with an average time of 6.9mo vs 1.3mo (p < 0.00001). Colonoscopy completion rates after symptom onset for NW and W patients at 2-months was 11% vs 81% and 33% vs 98% at 4-months (p < 0.0001, respectively). Rate of access to specialty care once diagnosed was not statistically significant for either groups, but there is a lower percentage of all YO-RC patients who accessed onco-fertility (13%, n = 11) or genetics services (46%, n = 38). The median 1-year overall survival was 50% for NW patients vs 85.7% for W patients, which was statically significant on univariate analysis (p = 0.04), but not on multivariate analysis. Conclusions: We found significant disparities for YO-RC from symptom onset to diagnosis with longer delays noted in NW patients. Such delays in diagnosis may lead to higher staging upon presentation and impact survival. Once a diagnosis was made, access to specialty oncology care rates was similar across groups. This study encourages further evaluation and consideration of socioeconomic factors and care access patterns to address disparities in diagnosis, access, and treatment of YO-CRC. Differences in diagnosis and dare access by race. White (n = 63) Non-White (n = 20) Stage at diagnosis I II-III IV 3 (5%) 48 (76%) 12 (19%) 0 (0%) 15 (75%) 5 (25%) Average Time from Symptom Onset to Diagnosis 1.3 months 6.9 months Location of Initial Abdominopelvic Imaging ER or admission Outpatient 19 (30%) 39 (70%) 8 (40%) 12 (60%) Care Providers Accessed Colorectal surgery 60 (95%) 19 (95%) Radiation oncology 46 (73%) 18 (90%) Medical oncology 56 (89%) 19 (95%) Onco-fertility 8 (13%) 3 (5%) Genetics 30 (48%) 8 (40%)