EP214 - Does traveling farther for care impact early-onset colorectal cancer survival?

Purpose/Background: Despite an overall increase in colorectal cancer (CRC) survival in the last 20 years, incidence and mortality of early-onset CRC (EOCRC) impacting individuals younger than 50 has increased. EOCRC is multifactorial and related to both individual and population-level exposures, but it is not clear how regionality, rurality, and traveling for care impact survival.

Methods/Interventions: Using the National Cancer Database (NCDB, 2004-2022), we 1) characterized and compared the EOCRC population to the average-onset (AOCRC) population, and 2) analyzed individual (sex, race, stage, insurance, comorbidities, chemotherapy, surgery, surgical approach, distance to care) and population-level (regional income, regional educational attainment, rurality) factors associated with survival among EOCRC. We defined "traveling farther" for care as traveling greater than the median travel distance within urban and rural groups. We used accelerated failure-time models to assess 5-year survival; time ratios (TR) and 95% confidence intervals (CI) are reported.

Results/Outcomes: Among 58,497 EOCRC individuals and 322,697 average-onset CRC patients, more EOCRC patients were non-white (32% vs 24%;p <.001), late-stage (38% vs 34%;p <.001), and had rectal cancer (43% vs 34%;p <.001) compared to AOCRC patients. EOCRC patients traveled farther for care than AOCRC patients, and more underwent robotic surgery (15% vs 12%;p <.001) and chemotherapy (74% vs 52%;p <.001). In adjusted survival models for both age-groups, survival was highest for those living in regions with high income and educational attainment. In the EOCRC group, urban patients who traveled farther for care had 5% longer survival (TR 1.05, 95%CI 1.02-1.08) than urban patients who did not travel or rural patients regardless of travel (Figure 1). Undergoing surgery was associated with improved survival for both age groups; chemotherapy was associated with 5% shorter survival among EOCRC (TR 0.95, 95%CI 0.91-0.98) but approximately 200% longer survival among AOCRC (TR 2.06, 95%CI 2.03-2.08).

Conclusion/Discussion: EOCRC individuals living in urban areas experienced improved survival when traveling farther for care, though their rural EOCRC counterparts did not necessarily gain the same survival benefit by traveling for care. Future work should examine barriers to traveling for care among EOCRC rural patients, as well as methods to improve the quality of rural EOCRC care where possible, to better understand resource availability in rural populations.

Figure 1
Figure 1. Accelerated failure time model survival estimates for patients with early-onset colorectal cancer. Estimates represented are time ratios, errors bars represent 95% confidence intervals. Reference group for rurality/travel variables is urban + no travel.