Treatment Delays and Survival Divides: Race, Sex, and Early-Onset Colorectal Cancer Disparities

Our study examined the association between sex, race/ethnicity, and treatment timeliness with cause-specific survival (CSS) and overall survival (OS) among patients with early-onset colorectal cancer (EOCRC; diagnosed <50 years of age). We conducted a retrospective cohort analysis using data from the 2006 to 2020 Surveillance, Epidemiology, and End Results Program. Exposures were sex, race/ethnicity [non-Hispanic White (NHW), non-Hispanic Black (NHB), non-Hispanic Asian/Pacific Islanders (Asian/PI), non-Hispanic American Indian/Alaskan Native (AI/AN), and Hispanic], and treatment timeliness. Outcomes were CSS for colorectal cancer death and OS for any causes of death. Cox proportional models were applied. Among 79,090 patients with EOCRC, females (73.1% vs. 72.8% for males) were more likely to receive timely treatment and males had higher proportion of delay (7.5% vs. 6.9% for females; P < 0.001). Racial minorities had significantly greater delays (AI/AN 5.3%, Hispanic 4.2%, NHB 3.4%, Asian/PI 3.1% vs. NHW 2.2%; P < 0.05). Adjusted Cox models showed elevated colorectal cancer and overall mortality among males (14%-18% for CSS and 15%-20% for OS; P < 0.05) and NHB patients (23%-37% for CSS and 21%-34% for OS; P < 0.05) compared with females and NHW patients, respectively. Hispanic patients with no/unknown treatment had 22% higher colorectal cancer mortality [95% confidence interval (CI), 1.03-1.44] and 23% higher overall mortality (95% CI, 1.06-1.44). AI/AN/Asian/PI individuals had a 19% increased risk of overall mortality with delayed treatment (95% CI, 1-1.42). In conclusions, male and NHB patients had poorer CSS and OS regardless of treatment timing. Hispanic/AI/AN/Asian/PI patients faced higher mortality with delayed/undocumented treatment timing.

Targeted strategies should focus on improving timely access to high quality of care for AI/AN/Asian/PI patients while also addressing barriers beyond treatment timeliness, particularly for male and NHB patients.