Impact of dedicated care coordination on access to multidimensional support services in young-onset colorectal cancer: A pragmatic trial.

Abstract

11008 Background: The incidence of young-onset colorectal cancer (YOCRC) is increasing, and affected patients experience distinct challenges. YOCRC patients may benefit from a dedicated care coordinator that systematically assesses their unmet needs and facilitates referrals to multidimensional support services. Methods: In this pragmatic trial, we assigned newly diagnosed CRC patients aged <50 years who presented to a tertiary academic institution between 2023-2025 to usual multidisciplinary care, or usual care plus additional encounter(s) with a dedicated care coordinator as a part of the YOCRC program. Patient-reported concerns and distress were collected at initial presentation. The primary endpoint was the rate of utilization of support services designed to address multidimensional needs of YOCRC patients. Multivariable regression was performed to identify predictors of service utilization. Results: Among 1,250 YOCRC patients (mean age 42.8±6.0 years; 45.4% female; 77.3% white), 46.3% had rectal cancer. Emotional concerns were most common (41.0%), followed by physical (36.1%), practical (27.8%) and social (9.4%) concerns. The YOCRC coordinator successfully established contact with 604 individuals. Clinically significant distress (distress score ≥4) was reported by 27.4%, with no significant difference between groups (26.5% vs. 29.2%, p=0.34). Unmet service needs were reported by 39.1% in the intervention group, of whom 80.5% subsequently accessed corresponding support services. Patients with established contact with the YOCRC coordinator were more likely to access support services (Table 1, 72.5% vs.44.7%, p<0.001). On multivariable analysis, coordinator contact (aOR 1.48, 95%CI 1.22-1.80), rectal cancer diagnosis (aOR 1.36, 95%CI 1.13-1.62), and clinically significant distress (aOR 1.23, 95%CI 1.01-1.50) predicted greater multidimensional service utilization. Conclusions: YOCRC patients experience substantial emotional concerns and unmet needs. Integration of a YOCRC coordinator was associated with significantly increased utilization of multidimensional support services. This pragmatic trial supports a personalized, needs-driven care delivery model, that integrates patient-reported outcomes to further optimize targeted referrals. Multidimensional support services accessed by YOCRC patients with vs. without established contact with YOCRC coordinator. Contact Established (n=604) Contact Not Established (n=646) p Social Work 378 (62.6%) 288 (44.6%) <0.01 Genetics 229 (37.9%) 126 (19.5%) <0.01 Wound, Ostomy, Continence 196 (32.5%) 69 (10.7%) <0.01 Supportive care 92 (15.2%) 77 (11.9%) 0.09 Oncofertility 77 (12.7%) 39 (6.0%) <0.01 Integrative Medicine 73 (12.1%) 34 (5.3%) <0.01 Nutrition 46 (7.5%) 40 (6.2%) 0.32 Psychiatry 41 (6.8%) 19 (2.9%) <0.01 Adolescent and Young Adult Program 58 (9.6%) 29 (4.5%) <0.01