Geographic and Demographic Disparities in Receipt of Treatment for Early-Onset Colorectal Cancer

PurposeTo examine disparities in receipt of the first course of treatment modality used among individuals diagnosed with early-onset colorectal cancer, focusing on sex, race/ethnicity, and rurality differences.MethodsWe conducted a cross-sectional analysis utilizing national data from the 2006-2020 Surveillance, Epidemiology, and End Results Program among adults aged 20-49. Key factors included sex, race/ethnicity, and rurality. Our main outcomes were whether patients started treatment, and which types they received. Multivariable logistic regression models were performed.ResultsOf total 82,427 patients, males (54.9%, p=0.097), racial minorities (0.8%-23.3%, p<0.001), and patients in all urban areas (70.7%; p<0.001) had higher rates of no treatment. Adjusted analysis showed that male patients had16%-19% lower odds of receiving surgery regardless of rurality (p<0.05) compared with female patients. In all/mostly urban areas, Black patients were found to had 17%-41% lower odds of receiving any treatment modalities (p<0.05); Hispanic patients had 11%-24% lower odds of receiving any treatment modalities (mostly urban: OR, 0.76; 95% CI, 0.60-0.95) or surgery alone (all urban: OR, 0.89; 95% CI, 0.84-0.95) compared with White patients. In rural areas, 33% and 34% lower odds of receiving radiation treatment were found among American Indian (AI)/Alaska Native (AN) (OR, 0.67; 95% CI, 0.46-0.98) and Asian/Pacific Islander (PI) patients (OR, 0.66; 95% CI, 0.44-0.99) compared with White patients, respectively.ConclusionsDisparities in receipt of surgery treatment were observed in males regardless of rurality. Black and Hispanic patients in urban areas had lower treatment use, while AI/AN and Asian/PI patients in rural areas were less likely to start radiation. Targeted approaches for specific groups are needed.