Treatment Delays and Survival Divides: Race, Sex, and Early-Onset Colorectal Cancer Disparities

Our study examined the association between sex, race/ethnicity, and treatment timeliness with cause-specific survival (CSS) and overall survival (OS) among patients with early-onset colorectal cancer (EOCRC, diagnosed < 50 years). We conducted a retrospective cohort analysis using data from the 2006-2020 Surveillance, Epidemiology, and End Results Program. Exposures were sex, race/ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], non-Hispanic Asian /Pacific Islanders [Asian/PI], non-Hispanic American Indian/Alaskan Native [AI/AN], Hispanic), and treatment timeliness. Outcomes were CSS for CRC death and OS for any causes of death. Cox proportional models were applied. Among 79,090 EOCRC patients, females (73.1% vs. 72.8% for males) were more likely to receive timely treatment and males had higher proportion of delay (7.5% vs. 6.9% for females) (p < 0.001). Racial minorities had significantly greater delays (AI/AN 5.3%, Hispanic 4.2%, NHB 3.4%, Asian/PI 3.1% vs. NHW 2.2%; p < 0.05). Adjusted Cox models showed elevated CRC and overall mortality among males (14%–18% for CSS and 15%–20% for OS; p < 0.05) and NHB patients (23%–37% for CSS, 21%–34% for OS; p < 0.05) compared to females and NHW patients, respectively. Hispanic patients with no/ unknown treatment had 22% higher CRC mortality (95% CI: 1.03–1.44) and 23% higher overall mortality (95% CI: 1.06–1.44). AI/AN/Asian/PI individuals had a 19% increased risk of overall mortality with delayed treatment (95% CI: 1.00–1.42). In conclusions, male and NHB patients had poorer CSS and OS regardless of treatment timing. Hispanic/AI/AN/Asian/PI patients faced higher mortality with delayed/undocumented treatment timing.