Real-world social determinants of health (SDOH) and outcomes of early-onset colorectal cancer (EO-CRC): An analysis of a large, nationally representative US community oncology network.

Abstract

11005 Background: The rise of EO-CRC in individuals under the age of 50 presents a major public health challenge, as these patients may encounter unique barriers to both screening and treatment. Understanding the drivers and implications of EO-CRC is crucial, and real-world data (RWD) can serve as a valuable tool by offering insights into evolving diagnostic, utilization, and practice landscapes, with robust information on social determinants of disease burden. Building on existing disparity concerns, this study leveraged RWD from a large, nationally diverse network of US community oncology practices to describe the SDOH and outcomes of patients with EO-CRC. Methods: This retrospective observational cohort study examined adult CRC patients within The US Oncology Network and non-Network practices, encompassing over 2,500 community-based providers treating more than 1.4 million patients annually. All patients diagnosed with CRC between 2000 and 2024 were included; patients were categorized as EO-CRC if they were < 50 years at first diagnosis and average-onset (AO)-CRC otherwise. Patient characteristics were sourced from iKnowMed, an oncology-specific electronic health record system, and descriptively summarized. Overall survival (OS) was assessed from diagnosis using Kaplan-Meier methods. Results: A total of 104,281 patients were identified, including 14,611 (14%; median age: 44 years) with EO-CRC and 89,670 (86%; median age: 67 years) with AO-CRC. Patients in the EO-CRC cohort were more likely to be Black (11% vs. 8%), American Indian or Alaska Native race (1.3% vs. 0.9%), of a documented race other than White (20% vs. 15%), and of Hispanic/Latino ethnicity (11% vs. 8%) versus the AO-CRC cohort. Few of EO-CRC (11%) and AO-CRC (10%) patients were current smokers at time of diagnosis. More than one-third of EO-CRC group was obese (36%), slightly higher than in AO-CRC (31%). EO patients were more commonly located in urban areas (69% vs. 63% of AO patients). Among 2,810 patients with Distress Thermometer data, EO-CRC patients were more likely to report high or moderate distress (29% vs. 22%) and less likely to report low distress (71% vs. 78%). 5-year OS probability was 72% (95% CI: 71-73) for EO-CRC and 64% (95% CI: 63-64) for AO-CRC. Conclusions: In one of the largest cohorts of patients with EO-CRC to date, this study confirmed that EO-CRC is an emerging concern within the US community oncology setting, particularly regarding heightened disparities in race, ethnicity, and lifestyle factors. EO patients may face unique burdens related to timely screening and diagnosis, necessitating tailored and cross-disciplinary approaches to their care, and warranting additional investigation into social and clinical drivers of survival outcomes to improve long-term prognosis.