Treatment delays of 6 weeks or longer following diagnosis were associated with poorer overall survival among patients with early age–onset colorectal cancer in a Texas registry study.
Researchers also found that neighborhood-level language barrier and minority-status vulnerability was associated with delayed treatment, highlighting a potential care delivery disparity in this population.
In the retrospective, population-based cross-sectional study, researchers analyzed Texas Cancer Registry data from 112,672 patients diagnosed with colorectal cancer from 2004 to 2019. Of these patients, 12,079 had early age–onset colorectal cancer (EOCRC), defined as diagnosis before age 50 years, and 100,593 had average age–onset colorectal cancer, defined as diagnosis at age 50 years or older.
Treatment delay was defined as initiation of definitive therapy at least 42 days following tissue diagnosis. The main outcomes included EOCRC status and treatment delays; researchers also assessed overall survival and patient- and system-level factors associated with delayed treatment.
Patients with EOCRC were more likely than older patients to be Hispanic, have left-sided or rectal tumors, and present with metastatic disease. Hispanic patients accounted for 28% of the early age–onset cohort compared with 20% of the average age–onset cohort. Metastatic disease was present in 25% vs 18%, respectively.
Despite presenting more often with advanced disease, patients with EOCRC had better overall survival than those with average age–onset disease in adjusted and unadjusted analyses. In the adjusted Cox model, early-onset disease was associated with lower mortality compared with average age–onset disease (hazard ratio = 0.73). The model adjusted for sex, race and ethnicity, stage, primary payer, primary tumor site, Social Vulnerability Index, treatment delay, and age younger than 50 years.
Across the overall colorectal cancer cohort, treatment delays were independently associated with worse overall survival, with a 29% higher hazard of death at any given time. Among patients with EOCRC, treatment delay was also associated with poorer survival in a 42-day landmark analysis, including analyses stratified by localized, regional, and metastatic disease. However, the stage-stratified survival comparisons were unadjusted, and the metastatic-disease association was weaker than the localized and regional findings.
To identify factors associated with treatment delays among patients with EOCRC, researchers evaluated the 4 major themes of the Social Vulnerability Index: socioeconomic status, household composition and disability, racial and ethnic minority status and language barriers, and housing and transportation.
Only the language barrier/minority status theme was associated with treatment delay in the adjusted model, corresponding to 1.45 times the odds of delay for patients in the most vulnerable areas compared with those in the least vulnerable areas. Because the Social Vulnerability Index is measured at the census-tract level, this finding reflects neighborhood-level vulnerability rather than directly documented individual language proficiency. In a sensitivity analysis replacing the combined theme with language barriers only, the findings were unchanged.
The researchers also found that male sex, metastatic disease, left-sided tumors, rectal tumors, Medicare, Medicaid, and uninsured status were associated with higher odds of treatment delay compared with the relevant reference groups.
The study had several limitations. As an observational analysis of registry data, it could not establish causality and was subject to unmeasured confounding and selection bias. The data set lacked granular information on comorbidities that may have affected treatment decisions and survival, and survival estimates may have been affected by incomplete death ascertainment or patient outmigration. The analysis also measured time from diagnosis to first definitive therapy and did not capture diagnostic delays prior to tissue diagnosis, which may contribute to advanced-stage presentation among younger patients.
“Language barriers could be a potentially modifiable risk factor associated with delayed treatment and may provide an opportunity to improve timely care and outcomes in EOCRC,” wrote lead study author Ryan T. Heslin, MD, of UT Southwestern Medical Center, Dallas, and colleagues.
Disclosures: Dr Zeh reported personal fees from Surgical Safety Technologies for serving on the scientific advisory board outside the submitted work. Dr Kim reported grants from the Eugene P. Frenkel, M.D. Scholar in Clinical Medicine from UT Southwestern Medical Center, the National Institutes of Health/National Cancer Institute, and the Cancer Prevention & Research Institute of Texas outside the submitted work.
Source: JAMA Oncology
