Rurality, poverty linked to shorter survival in early-onset colorectal cancer
Click Here to Manage Email Alerts
Key takeaways:
- Analyses of people with early-onset colorectal cancer showed those who lived in rural communities had shorter disease-specific survival than those in urban areas.
- Poverty level contributed to mortality risk.
Analyses of people with early-onset colorectal cancer showed those who lived in rural areas had greater 5-year disease-related mortality risk than those who lived in nonrural areas, according to results of a retrospective study.
Cancer-specific mortality also increased nearly 50% for patients aged 30 to 39 years if they lived in impoverished areas.
“The [young adult] findings surprised me,” Meng-Han Tsai, PhD, assistant professor at Georgia Cancer Center at Augusta University, told Healio. “This is particularly concerning because [they are younger than] the recommended screening age and may not be aware of colorectal cancer risk [or] symptoms, [and they may] lack of access to appropriate care.”
Background and methods
Incidence of early-onset colorectal cancer — defined as diagnosis prior to age 50 years — has been increasing steadily in the United States..
Colorectal cancer — which had been the fourth leading cause of cancer deaths in the 1990s for both men and women younger than age 50 — now is the top cause of cancer death among men younger than 50 and the second-leading cause of death among women that age.
Prior studies showed people living in poor and rural communities had higher risk for colorectal cancer death; however, whether this trend existed in the context of early-onset disease had not been established.
“Such understanding is vital [to] inform health system policies aimed at improving equitable access to care for young populations and low resource communities,” Tsai said.
Tsai and colleagues used SEER data from 2006 to 2015 to evaluate associations between early-onset colorectal cancer and rurality or persistent poverty.
Researchers identified 58,200 people (53% men) with early-onset disease. About three-quarters (73.4%) were aged 40 to 49 years.
Five-year early-onset colorectal cancer mortality served as the primary endpoint.
Results and next steps
Researchers reported a higher rate of 5-year colorectal cancer survival among individuals who lived in nonrural, non-impoverished areas than those who lived in persistent poverty, regardless of rurality (71.8% vs. 66.5%).
Rurality increased early-onset colorectal cancer mortality risk regardless of age and poverty (HR = 1.11; 95% CI, 1.1-1.24).
In the rural/non-impoverished cohort, individuals aged 20 to 29 years had the highest risk for colorectal cancer risk (HR = 1.35; 95% CI, 1.06-1.71), followed by those aged 30 to 39 years (HR = 1.26; 95% CI, 1.12-1.42) and those aged 40 to 49 years (HR = 1.12; 95% CI, 1.06-1.19).
Individuals who lived in both rural areas and poverty exhibited higher risk for colorectal cancer mortality than those who lived in nonrural areas (HR = 1.29; 95% CI, 1.18-1.42). The elevated risk appeared particularly high among those aged 30 to 39 years (HR = 1.51; 95% CI, 1.22-1.88) but remained elevated for those aged 40 to 49 years (HR = 1.26; 95% CI, 1.13-1.41).
“This intersecting association with risk [for] colorectal cancer death was also more pronounced for patients with early-onset colorectal cancer by 30% compared with 19% in average-onset colorectal cancer,” Tsai and colleagues wrote.
Factors contributing to this could include later-stage diagnoses, underinsurance, lower-quality treatment and comorbidities such as obesity, researchers wrote.
“Implications that may be considered [include] education programs aimed at encouraging healthy lifestyles and symptom awareness tailored to young populations, patient-centered communication tailored to these young adults through primary care [initiatives, and] health-system policies [that invest] more resources in cancer diagnosis and treatment for low-resource communities,” Tsai said.
Researchers acknowledged study limitations, including lack of information on lifestyle factors, comorbidities and structural barriers.
“Future research examining the multifaceted factors associated with early-onset colorectal cancer diagnosis and mortality is needed, including multilevel social determinants of health and clinical presentations,” Tsai said. “More small area research may also be helpful for informing interventions [or] programs tailored to specific geographic groups when considering their unmet needs. We really need ... integrated care connecting providers and communities for these preventive efforts for young populations and low-resource communities.”
For more information:
Meng-Han Tsai, PhD, can be reached at metsai@augusta.edu.
Collapse
Click Here to Manage Email Alerts