Healthcare resource utilization and predictors of supportive care referrals in early-onset colorectal cancer patients.

119 Background: Patients with early-onset colorectal cancer (EOCRC; diagnosis < 50 years) face complex oncological and supportive care needs, yet patterns of healthcare utilization remain underexplored. We assessed the frequency, completion, and predictors of supportive care referrals in this population. Methods: This was a prospective cohort study of patients aged 18–49 diagnosed with colorectal adenocarcinoma between 2019–2024 and enrolled in the Cleveland Clinic Center for Young Onset CRC Registry. Patients were informed of available multidisciplinary services. Referrals were made based on interest. Demographic, clinical, and utilization data were extracted from electronic medical records. Outcomes included referral/completion rates, and predictors of referral using multivariable logistic regression. Results: Among 500 patients, median age at diagnosis was 42 yrs; 53% were female, 73% were White, and 34% had Stage IV disease. The rectum was the most common tumor site (52%). Supportive care referrals varied: 39% for psychology, 36% for wellness, 36% for nutrition, and 24% for palliative care. Completion varied: 93% for palliative care, 90.6% for social work, but only 12% for nutrition. Depression was associated with higher odds of interest in psychology (OR 2.2, p = 0.039) and nutrition (OR 2.1, p = 0.040). Stage IV disease was associated with uptake of palliative care (OR 3.5, p < 0.001) and nutrition (OR 1.7, p = 0.018). Obesity was associated with lower odds of interest in palliative care (OR 0.6, p = 0.029) and social work (OR 0.6, p = 0.010). White patients were less likely to express interest in psychology referrals (OR 0.5, p = 0.032), while women were more likely to pursue wellness services than men (OR 1.6, p = 0.026). Conclusions: Supportive services were underutilized despite systematic counseling. Referral patterns reflected clinical and sociodemographic factors, suggesting that disease burden, psychosocial needs, and personal preference shape engagement. These findings underscore the need to proactively address barriers to uptake and integrate supportive care into the routine management of EOCRC. Specialty referrals and completion rates in EOCRC. N Referral (%) Referral completion (%) Genetics 500 368 (74) 314 (85) Colorectal surgery 500 438 (88) 438 (100) Oncology 500 466 (93) 465 (100) Radiation oncology 500 267 (53) 267 (100) Liver surgery 500 119 (24) 117 (98) Thoracic surgery 500 35 (7) 34 (97) Gastroenterology 500 254 (51) 253 (100) Psychology 500 196 (39) 120 (61) Social work 500 276 (55) 250 (91) Wellness, preventative, & integrative medicine 500 182 (36) 89 (49) Nutrition 500 180 (36) 21 (12) Palliative medicine 500 121 (24) 113 (93) Male Sexual Health 283 67 (24) 50 (75) Male fertility preservation 283 20 (7) 16 (80) Female fertility preservation 217 4 (2) 3 (75) Female Hormonal & Sexual Health 217 56 (26) 27 (48) Maternal Fetal Medicine 1* 1 (100) 1 (100) *Our cohort included only one pregnant woman, who was referred to maternal-fetal medicine and successfully completed the referral.