Comprehensive analysis of socioeconomic and clinical factors contributing to treatment delay in early-onset colorectal cancer.

Abstract

32 Background: The prevalence of early-onset colorectal cancers (EOCRC) is rising globally. Disparities in social determinants of health can delay access to treatment and impacting outcomes. This study aims to analyze factors influencing time from diagnosis to treatment among EOCRC patients in a racially diverse population, considering tumor factors and sociodemographics. Methods: We analyzed EOCRC data from patients diagnosed between 2000 and 2022 at Queen’s Medical Center in Honolulu, Hawaii. Time from diagnosis to treatment for Asians, Whites, and Native Hawaiian or Other Pacific Islanders (NHOPI) was assessed using the Kaplan-Meier Method. Cox proportional hazards regression models were used to identify predictors, adjusting for clinical and pathological factors. Results: A total of 379 patients were analyzed. NHOPI were more like to be underinsured compared to Whites and Asians. In the unadjusted Cox model, underinsured/uninsured status, older age, unknown stage, left sided, and rectal locations were associated with delayed treatment. After adjustment, underinsured/uninsured status, older age, and rectal location remained significant predictors of delayed treatment. Conclusions: EOCRC patients with underinsured/uninsured status, age, and rectal tumor location are significantly associated with delayed in cancer treatment. While age was statistically significant, its clinical impact appears minimal. The need for a multidisplinary approach and additional preoperative staging in rectal cancer may explain treatment delays even after adjustment. Improving treatment accessibility and reducing delays, especially for underinsured EOCRC patients, is important. Univariate and multivariate analysis of time from diagnosis to treatment. Univariate Multivariate HR (95% CI) p-value HR (95% CI) p-value Insurance - - - - Private insurance - - - - Underinsured/Uninsured 0.692 (0.545-0.878) 0.003 0.706 (0.55-0.906) 0.006 Race White - - - - Asian 0.912 (0.696-1.195) 0.503 0.817 (0.619-1.077) 0.151 NHOPI 0.749 (0.548-1.025) 0.071 0.779 (0.562-1.08) 0.134 Age 0.978 (0.96-0.997) 0.021 0.968 (0.949-0.987) 0.001 Histopathology grade Grade 1&2 - - - - Grade 3&4 1.046 (0.798-1.371) 0.746 1.083 (0.813-1.441) 0.587 Stage 1 - - - - 2 1.022 (0.718-1.456) 0.902 1.071 (0.744-1.539) 0.713 3 1.227 (0.896-1.682) 0.203 1.387 (0.997-1.931) 0.052 4 0.964 (0.673-1.381) 0.842 1.039 (0.716-1.507) 0.842 Unknown 0.631 (0.406-0.981) 0.041 0.748 (0.473-1.182) 0.213 Sex Male - - - - Female 1.029 (0.836-1.267) 0.785 1.072 (0.868-1.325) 0.518 Microsatellite status Stable - - Unstable 1.074 (0.616-1.875) 0.8 Not done/Unknown 1.259 (1.004-1.577) 0.046 Location of Tumors Right - - - - Left 0.631 (0.468-0.851) 0.003 0.735 (0.535-1.011) 0.058 Rectal 0.43 (0.317-0.582) <0.001 0.448 (0.327-0.613) <0.001 NHOPI: Native Hawaiians and Other Pacific Islanders. HR: Hazard Ratio CI: Confidence Interval.