San Francisco, CA - 2020 Gastrointestinal Cancers Symposium – Atendeew during General Views at the 2020 Gastrointestinal Cancers Symposium here today, Thursday January 23, 2020. Photo by © ASCO/Todd Buchanan 2020

Results from a retrospective analysis of 26,768 young adults age 40 and under, presented at the 2020 Gastrointestinal Cancers Symposium taking place January 23-25, 2020 in San Francisco, California, demonstrated that patients living in areas with lower income (less than US $ 38,000) and lower education (under 79% high school graduation rate), as well as those who live in urban areas, had worse outcomes and a higher risk of death.

More than 16,000 people under age 50 are diagnosed with colorectal cancer in the United States, and incidence rates among this population have risen 51% since 1994 with the sharpest increase among those age 20 to 29[1].

ASCO“There are a lot of disparities in health care,” noted lead author, Ashley Matusz-Fisher, MD, Levine Cancer Institute, Charlotte, NC.

“It is important to look at the sociodemographic disparities so that we can learn more and try to eliminate them,” Matusz-Fisher added.

Sociodemographic disparities
Previous studies have explored sociodemographic disparities in patients with cancer, including those with colorectal cancer.

However, according to the authors of this study, this is the first study designed to explore sociodemographic disparities in young adults with colorectal cancer and to study whether residential location correlates with outcomes such as overall survival.

Researchers used data from the National Cancer Database of 26,768 young adults who were diagnosed with colorectal cancer between 2004 and 2016. About half of the patients were male (51.6%) and half were female (48.4%). The majority of patients were white (78.7%), 14.6% were black, and 6.6% were other races.

Researchers categorized patients based on whether they lived in areas of low or high income and education. About 32% of patients resided in the highest income areas ($68,000 or greater median income) and 18.4% lived in areas with the lowest income ($38,000 or lower median income). About a quarter of patients (23%) lived in areas with the highest high school graduation rates (at least 93% of students graduate) and 20% lived in areas with the lowest rates (less than 79% of high school students graduate). In addition, about 32% lived in metropolitan areas and 18.4% lived in urban areas.

Study results
According to the study’s authors, young adult patients from the lowest income and education areas had a 24% increased risk of death compared with those from the highest income and education areas.

The authors also noted that after researchers adjusted for race, insurance status, stage of cancer, and comorbidities, they found that patients from urban areas had a 10% increased risk of death compared with those from metropolitan areas, regardless of income.

Senior author, Mohamed E. Salem, MD, gastrointestinal oncologist and associate professor of medicine at Levine Cancer Institute, Charlotte, NC.

Patients diagnosed with stage IV cancer in the lowest income areas also had worse median overall survival as compared with those residing in higher income areas.

Finally, researchers found that patients in the lowest income areas were more likely to be black, not have private health insurance, have more comorbidities, and present with more advanced cancer.

Type of disparities
“Disparities do not necessarily translate to racial or ethnic differences. There exist many other types of disparity among our patients that affect the availability of and access to cancer care, and likely will influence patient outcomes,” said the senior author, Mohamed E. Salem, MD, gastrointestinal oncologist and associate professor of medicine at Levine Cancer Institute, Charlotte, NC.

“Although awareness of health care disparities has increased, considerable knowledge gaps still exist, particularly among young adults with cancer. Therefore more effort to increase awareness regarding health care disparities is warranted to provide access and remove barriers to care so that we can eliminate disparities and achieve health equity,” Salem added.

Commenting on the study results, Richard L. Schilsky, MD, FACP, FSCT, FASCO, ASCO Chief Medical Officer and Executive Vice President, noted: “We’ve recently seen a concerning trend that colorectal cancer incidence in young adults is on the rise. Coupled with the findings from this study, which show how colorectal cancer outcomes in young adults are impacted by where they live, it is clear this issue needs greater attention. Every patient with cancer should have access to the highest quality cancer care, no matter where they live.

Results from other studies confirming the impact of disparities in care were presented during the annual meeting of the American Society of Hematology (ASH), held December 7 – 10, 2019 in Orlando, Florida.  These studies paint a mixed portrait of how demographics and socioeconomic status affect access to clinical trials and effective treatments for patients with blood cancers.[2]

References
[1] Siegel RL, Fedewa SA, Anderson WF, Miller KD, Ma J, Rosenberg PS, Jemal A. Colorectal Cancer Incidence Patterns in the United States, 1974–2013. JNCI: Journal of the National Cancer Institute, Volume 109, Issue 8, August 2017.  https://doi.org/10.1093/jnci/djw322
[2] Hofland P. Addressing Disparities in Cancer: Factors Influencing Care, Access and Outcomes. Onco’Zine, December 8, 2019.[Link]