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. 2021 May;17(5):e614-e622.
doi: 10.1200/OP.20.00777. Epub 2021 Jan 11.

Disparities in Characteristics, Access to Care, and Oncologic Outcomes in Young-Onset Colorectal Cancer at a Safety-Net Hospital

Benjamin D Fangman  1 , Suleyman Y Goksu  1   2 , Nivan Chowattukunnel  1 , Muhammad S Beg  2 , Nina N Sanford  3 , Aravind Sanjeevaiah  2 , John Cox  2 , Michael R Folkert  3 , Todd A Aguilera  3 , Joselin Mathews  4 , Javier Salgado Pogacnik  4 , Gaurav Khatri  5 , Craig Olson  4 , Patricio M Polanco  4 , Udit Verma  2 , David Hsiehchen  2 , Amy Jones  2 , Radhika Kainthla  2 , Syed M Kazmi  2
Affiliations

Disparities in Characteristics, Access to Care, and Oncologic Outcomes in Young-Onset Colorectal Cancer at a Safety-Net Hospital

Benjamin D Fangman et al. JCO Oncol Pract. 2021 May.

Abstract

Purpose: Young-onset colorectal cancer is an emerging cause of significant morbidity and mortality globally. Despite this, limited data exist regarding clinical characteristics and outcomes, particularly in safety-net populations where access to care is limited. We aimed to study disparities in clinical characteristics and outcomes in patients with young-onset colorectal cancer in the safety-net setting.

Methods: We performed a retrospective review of patients < 50 years old diagnosed and/or treated for colorectal cancer between 2001 and 2017 at a safety-net hospital. Kaplan-Meier and Cox regression models were constructed to compare overall survival (OS), progression-free survival (PFS), and relapse-free survival (RFS) by race and ethnicity, stratifying for relevant clinical and pathologic factors.

Results: A total of 395 young-onset patients diagnosed at a safety-net hospital were identified and 270 were included in the analysis (49.6% Hispanic, 25.9% non-Hispanic Black, 20.0% non-Hispanic White, and 4.4% other). Non-Hispanic White race was independently associated with worse OS (hazzard ratio [HR], 0.53; 95% CI, 0.29 to 0.97), as were lack of insurance, higher clinical stage, and mismatch repair proficiency. There was no significant difference seen in PFS or RFS between racial and ethnic groups.

Conclusion: Non-Hispanic White race or ethnicity was found to be independently associated with worse OS in a safety-net population of patients with young-onset colorectal cancer. Other independent predictors of worse OS include higher stage, lack of insurance, and mismatch repair proficiency.

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Conflict of interest statement

Muhammad S. BegConsulting or Advisory Role: Ipsen, Array BioPharma, AstraZeneca/MedImmune, Cancer CommonsResearch Funding: Celgene, Bristol Myers Squibb, AstraZeneca/MedImmune, Merck Serono, Agios, Five Prime Therapeutics, MedImmune, ArQule, Genentech, Sillajen, CASI Pharmaceuticals, Immunesensor, Tolero Pharmaceuticals Aravind SanjeevaiahTravel, Accommodations, Expenses: NanoCarrier John CoxEmployment: University of Texas Southwestern Medical Center - Simmons Cancer CenterLeadership: Parkland Health SystemStock and Other Ownership Interests: Amgen, Medfusion, Merck, Pfizer, Johnson & JohnsonHonoraria: Association of Community Cancer Centers (ACCC), American College of Physicians, NCCN, NAS: National Cancer Policy ForumResearch Funding: US OncologyTravel, Accommodations, Expenses: American College of Physicians, Association of Community Cancer Centers (ACCC), NCCNOther Relationship: Mary Crowley Research Center, Dallas Texas, American Society of Clinical Oncology, Texas Oncology FoundationUncompensated Relationships: NCQA Michael R. FolkertResearch Funding: Boston ScientificTravel, Accommodations, Expenses: Boston Scientific Todd A. AguileraStock and Other Ownership Interests: Avelas Biosciences, Akso BiosciencesConsulting or Advisory Role: Apexigen IncResearch Funding: Apexigen Inc, Galera TherapeuticsPatents, Royalties, Other Intellectual Property: Patent from UCSD with royalties for licensing to Avelas Biosciences, Patent from Stanford with royalties for licensing to Akso Biosciences Udit VermaConsulting or Advisory Role: Bayer/OnyxNo other potential conflicts of interest were reported.

Figures

Fig 1.
Fig 1.
Study design.
Fig 2.
Fig 2.
(A) Overall survival (entire cohort) (logrank P = .02). (B) Overall survival (stage II-III) (logrank P = .021). Overall survival (stage IV) (logrank P = .011).
Fig 3.
Fig 3.
(A) Relapse-free survival (logrank P = NS). (B) Progression-free survival (logrank P = NS). NS, not significant.
See this image and copyright information in PMC

References

    1. Colorectum cancer statistics. American Cancer Society, 2020. https://cancerstatisticscenter.cancer.org/?_ga=2.121905480.2101098012.15...
    1. Willauer AN Liu Y Pereira AAL, et al. : Clinical and molecular characterization of early-onset colorectal cancer. Cancer 125:2002-2010, 2019 - PMC - PubMed
    1. Siegel RL, Miller KD, Jemal A: Cancer statistics, 2018. CA Cancer J Clin 68:7-30, 2018 - PubMed
    1. Ahnen DJ Wade SW Jones WF, et al. : The increasing incidence of young-onset colorectal cancer: A call to action. Mayo Clin Proc 89:216-224, 2014 - PubMed
    1. Murphy CC Wallace K Sandler RS, et al. : Racial disparities in incidence of young-onset colorectal cancer and patient survival. Gastroenterology 156:958-965, 2019 - PMC - PubMed