Retrospective population-based study of treatment delays in early age-onset colorectal cancer

The incidence of early age-onset colorectal cancer (EOCRC; diagnosed before age 50 years) is increasing. Delays in initiation of definitive therapy (defined as more than 6 weeks from diagnosis to initiation of definitive therapy) are associated with worse outcomes in average age-onset colorectal cancer (AOCRC), but their impact on EOCRC has not been comprehensively characterized. A retrospective population-based study using the Texas Cancer Registry (2004-2019) evaluated the incidence of EOCRC and patients affected by treatment delays. Among 112,672 patients with CRC 12,079 (11%) had EOCRC. Mean age at diagnosis was 41.6 ± 5.9 years in the EOCRC cohort and 68.2 ± 11.2 years in the AOCRC cohort. Compared to patients with AOCRC, patients with EOCRC were less likely to be of White race (53.2% versus 64.9%; p<0.001) and more likely to be of Hispanic ethnicity (28.1% versus 19.9%; pxtagstartz0.001). Median overall survival was not reached for patients with EOCRC and was 80 months for patients with AOCRC (HR 0.56; pxtagstartz0.001). In multivariable analysis, higher Social Vulnerability (HR 1.22; p<0.001) and treatment delays (HR 1.29; p<0.001) were associated with worse OS. The authors conclude that EOCRC was associated with improved overall survival compared with AOCRC, whereas treatment delays were independently associated with worse survival among patients with EOCRC.