Disparities in characteristics, access to care, and oncologic outcomes in young-onset colorectal cancer at a safety-net hospital

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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)E614-E622
JournalJCO Oncology Practice
Issue number5
StatePublished - May 1 2021

ASJC Scopus subject areas

  • Oncology
  • Health Policy
  • Oncology(nursing)


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