Trends, Disparities, and Outcomes in Time to Treatment Initiation in Patients With Early-Onset Colorectal Cancer

Abstract

Aims

The incidence of early-onset colorectal cancer (EOCRC) is on the rise globally. It is well documented in the literature that increased time to treatment initiation (TTI) results in higher mortality rates in malignancies. We conducted this study to explore trends, disparities, and outcomes in TTI in patients with EOCRC.

Methods

We conducted a retrospective cohort study using the National Cancer Database. We identified 56 333 patients less than 45 years of age who were diagnosed with colorectal cancer between 2004 and 2021 who had data on TTI. We calculated the average annual percentage change (AAPC) in TTI and assessed predictors of treatment delay and the degree to which they are associated with delays using logistic and linear regression, respectively. A Cox proportional hazards model was fit for each stage to assess 5-year, 10-year, and overall mortality.

Results

The overall AAPC was 1.50% (95% CI: 1.40–1.60, p < 0.001), with all variables showing positive AAPCs, but these varied significantly by sociodemographic factors. Sex, race, ethnicity, education, insurance, and comorbidity burden were predictors of treatment delay. There was increased overall mortality in Stage 2 (aHR = 1.48, 95% CI: 1.30–1.69, p < 0.001) and Stage 3 disease (aHR = 1.12, 95% CI: 1.03–1.21, p = 0.007) and decreased overall mortality in Stage 4 disease (aHR = 0.84, 95% CI: 0.79–0.88, p < 0.001) in patients who experienced treatment delays.

Conclusions

Treatment delays are increasingly common and strongly associated with insurance status, socioeconomic disadvantage, and race, with clinically meaningful delays of several days, while patients with advanced disease are prioritized for faster treatment. These provide public health stakeholders with important insights into inequities in the treatment of EOCRC.