Unique Considerations in Care Delivery for Early-Onset Gastrointestinal Cancers: A Narrative Review

The incidence of early-onset gastrointestinal (GI) cancers, typically defined by diagnosis before age 50 years, is rapidly rising in the United States and around the world. Although the underlying drivers of this trend are incompletely understood, emerging evidence suggests that environmental exposures and lifestyle factors play key roles. Patients with early-onset GI cancers face unique challenges over the course of their care. Young patients often experience diagnostic delays, present at more advanced stages, and have more aggressive tumor biology than their older counterparts. Patients with early-onset cancers are also frequently offered more intensive treatment, although with unclear benefit. Beyond these medical differences, early-onset patients may experience increased psychosocial distress compared with older patients, including higher rates of financial toxicity, childcare needs, depression and anxiety, concerns about relationships and sexuality, distress about fertility consequences, and disruption of educational and career trajectories. However, current clinical practice patterns often fail to adequately address the unique needs of early-onset patients. Although several large academic centers have modeled the implementation of specialized multidisciplinary programs to care for patients with early-onset colorectal cancer, broad access to these programs remains limited. Future work must evaluate the scalability of these models to other GI cancer sites across diverse care settings, as well as improve equitable access to timely diagnosis and optimal care for this growing patient population.