Receipt of surveillance in a population-based sample of survivors of early-onset colorectal cancer.

Abstract

638 Background: Early-onset colorectal cancer (EOCRC) incidence is rising but data on survival and recurrence compared with late-onset CRC remain limited, contributing to under- and over-use of surveillance. We evaluated receipt of surveillance in a diverse population-based sample of EOCRC survivors and identified factors associated with receipt. Methods: Survivors diagnosed 2019-23 at age 18-50 years with stage I-III CRC and reported to Georgia, Kentucky, or Los Angeles SEER registries were surveyed 1-5 years post-diagnosis (N=1261; 48% current response). We assessed receipt of surveillance 1) imaging (CT/MRI/PET) in the past 12 months, 2) endoscopy (sigmoidoscopy or colonoscopy) since resection, and 3) CEA blood test in the past 12 months, individually and as a composite measure of all 3 components. We excluded 240 patients with recurrence or new cancer. We used multivariable logistic regressions to estimate associations between receipt of surveillance and patient characteristics. Results: Among 1021 survivors, 65% reported receipt of imaging, 90% endoscopy, 68% CEA, and 37% receipt of all 3 components. The table shows associations between receipt of individual surveillance components and patient characteristics. Receipt of all 3 components was more likely in women vs. men (aOR 1.57, 1.16-2.12), college graduates vs. high school or less education (aOR 1.99, 1.30-3.04), those who received chemotherapy (aOR 3.97, 2.83-5.58) or radiation (aOR 1.56, 1.08-2.27) vs. those who didn’t, and less likely among Hispanic (aOR 0.56, 0.38-0.83) and Black (aOR 0.29, 0.19-0.45) vs. white survivors. Conclusions: Most EOCRC survivors reported receipt of endoscopy, about two-thirds reported receipt of imaging or CEA and only one-third reported receipt of all 3 surveillance components. Receipt differed by sex, race, ethnicity, income, education, and treatment. Ongoing work will assess whether surveillance aligns with recurrence risk across subgroups. Multivariable regression of receipt of individual surveillance components. Receipt of Imaging(OR, 95% CI) Receipt of endoscopy(OR, 95% CI) Receipt of CEA(OR, 95% CI) Sex Male (Ref) Female -1.28 (0.93-1.78) - 2.04 (1.25-3.33) - 1.80 (1.23-2.63) Race/Ethnicity White (Ref) Black Asian Hispanic - 0.58 (0.38-0.88) 0.75 (0.39-1.43)0.81 (0.53-1.25) - 0.35 (0.20-0.61) 3.99 (0.53-30.26)0.74 (0.39-1.38) - 0.27 (0.16-0.45) 1.07 (0.51-2.25) 0.51 (0.31-0.84) Education High school or less (Ref) Some college College graduate -1.29 (0.81-2.04)0.98 (0.62-1.56) -0.94 (0.52-1.69)1.34 (0.74-2.63) -1.80 (1.05-3.09) 1.86 (1.09-3.18) Annual Household Income <$40,000 (Ref) $40,000-$89,999 ≥$90,000 -0.89 (0.55-1.44)0.77 (0.46-1.28) -1.59 (0.84-2.82) 3.53 (1.72-7.27) -1.03 (0.59-1.81)1.08 (0.60-1.95) Chemotherapy No (Ref) Yes - 7.76 (5.52-10.92) -0.74 (0.45-1.22) - 5.04 (3.37-7.53) Radiation No (Ref) Yes -1.25 (0.78-2.02) -1.52 (0.80-2.90) -1.48 (0.86-2.56)