Distance to Care, Regional Context, and Survival in Early-Onset Colorectal Cancer

Despite an overall decrease in colorectal cancer (CRC) mortality in recent decades, incidence and mortality of CRC among individuals younger than 50 (early onset CRC; EOCRC) has increased. Individual and population-level exposures contribute to EOCRC, but it is not clear how rurality and traveling for care impact survival.

Using the National Cancer Database (NCDB, 2010-2022), we (1) characterized and compared the EOCRC population to the average-onset (AOCRC) population, and (2) analyzed individual and population-level sociodemographic and clinical factors associated with 5-year survival. We used accelerated failure-time models; hazard ratios (HR) and 95% confidence intervals (CI) are reported.

Among 404,440 individuals with CRC (15.7% EOCRC), more EOCRC patients were non-white (32.2% vs. 24.6%; p < 0.001), had rectal cancer (43% vs. 34%; p < 0.001), and presented at later stages compared to AOCRC patients. EOCRC patients traveled farther for care overall, and rural EOCRC patients with rectal cancer traveled farthest of any group (median 41.7 miles). In adjusted EOCRC survival models, compared to urban patients traveling for care, survival was worse for urban patients who did not travel (HR 1.09, 95% CI 1.05-1.12) and rural patients regardless of travel (rural, traveled: HR 1.12, 95% CI 1.07-1.18; rural, no travel: HR 1.16, 95% CI 1.09-1.22).

EOCRC individuals living in urban areas experienced improved survival when traveling farther for care, though their rural counterparts did not necessarily gain the same survival benefit by traveling. Using exposures and health behaviors to guide screening beyond age-based guidelines could improve early detection and survival.