Age as a determinant of systemic therapy initiation in advanced colorectal cancer: Experience from an urban safety-net hospital.

e13763 Background: Access is often cited as the primary hurdle in safety-net oncology, yet geriatric factors may drive treatment attrition. In urban settings with high insurance coverage but significant clinical complexity, the independent impact of age on therapy initiation remains poorly defined. We evaluated whether age dictates systemic therapy initiation for advanced colorectal cancer (CRC) in a predominantly minority safety-net population. Methods: We conducted a retrospective analysis of the Newark Beth Israel Medical Center cancer registry, identifying patients diagnosed with stage III–IV epithelial CRC between 2023 and 2024. The primary outcome was initiation of systemic therapy (chemotherapy and/or immunotherapy). Associations between treatment initiation and age, disease stage, insurance status, and race/ethnicity were evaluated using Fisher’s exact tests. Multivariable logistic regression was performed, modeling age as a continuous variable and adjusting for disease stage. Results: Among 44 patients included, 47.7% had stage III disease and 52.3% had stage IV disease. The cohort was predominantly Non-Hispanic Black (76.1%). Overall, 63.6% of patients initiated systemic therapy. Insurance status was not statistically associated with treatment initiation; notably, all untreated patients were insured, primarily through Medicare or Medicaid. Disease stage similarly showed no significant association with therapy receipt. In contrast, treatment initiation declined substantially with increasing age, from 71.4% among patients younger than 65 years to 28.6% among those aged 65 years or older (p = 0.003). On multivariable analysis, each additional year of age was associated with an 8% decrease in the odds of systemic therapy initiation (OR 0.92; 95% CI 0.86–0.97; p = 0.004). Documented medical contraindications and treatment refusal were uncommon contributors to non-initiation. Conclusions: In this safety-net cohort, increasing age was strongly associated with non-initiation of therapy despite insurance and advanced stage. Findings suggest care delivery decision-making, rather than access, may drive these disparities. Integrating structured geriatric assessments may help distinguish physiologic vulnerability from chronologic age, supporting individualized care in safety-net settings.