PPS7. Patient-reported disparities in early- versus later-onset colorectal cancer from All of Us

Thursday, March 5, 2026

10:00 AM - 10:30 AM MST

Location: HUB Poster Park - West Hall 1-3

Co-Author(s)

Natalie N. Chakraborty, MD (she/her/hers)

Research Fellow and General Surgery Resident
University Hospitals Cleveland Medical Center
Cleveland, Ohio, United States
ML

Melissa Lumish, MD

Assistant Professor
University Hospitals, Cleveland Medical Center
Cleveland, Ohio, United States
Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA

Attending
The Ohio State University Wexner Medical Center, Division of Surgical Oncology
Columbus, Ohio, United States
Richard S. Hoehn, MD

Surgeon
University Hospitals, Cleveland Medical Center
Cleveland, Ohio, United States

Poster Presenter(s)

Trisha Lal, MD (she/her/hers)

Resident
University Hospitals, Cleveland Medical Center
Cleveland, Ohio, United States

Introduction: Early-onset colorectal cancer (EOCRC) incidence continues to rise and is associated with a substantial psychological burden. Most patient-reported evidence is limited in sample size and lacks comparison to later-onset CRC (LOCRC). We aimed to quantify differences in patient-reported social support, discrimination, self-related health, and healthcare access/utilization between EOCRC and LOCRC.

Methods:

We conducted a cross-sectional study using the All of Us Research Program, a nationwide prospective cohort. The database was queried for participants with CRC who completed relevant survey items. EOCRC was defined as diagnosis < 50 years. Outcomes included low social support, perceived discrimination, fair/poor self-related health, healthcare access barriers, and inadequate utilization, each dichotomized per survey definitions. Multivariable logistic regression estimated odds ratios (OR) with 95% confidence intervals (CI) for EOCRC versus LOCRC, adjusting for demographics, socioeconomic status, insurance, marital status, year of diagnosis, and area-level deprivation.

Results:

Of 13,655 CRC participants, 11,068 (EOCRC n=1,373; LOCRC n=9,695) completed all survey items. EOCRC participants were more often female (64% vs 53.1%), privately insured (71.2% vs 45.7%), employed (68.1% vs 36%), and had higher education and income (all p < 0.001). EOCRC participants reported greater cost-related barriers, including inability to afford follow-up care (5.7% vs 3.1%), mental health services (8.6% vs. 2.7%), prescription medications (12.1% vs 6.4%), and specialist visits (8.6% vs 3.9%; all p < 0.001). Logistic barriers were also higher, such as delays due to copays (8.1% vs 2.8%) and time off work (11.5% vs 2.8%). EOCRC respondents also reported more frequent day-to-day discrimination, including being treated with less respect at the doctor’s office (all p < 0.001).

In adjusted models, EOCRC was associated with higher odds of low social support (OR 2.00, 95% CI 1.74-2.28), perceived discrimination (OR 1.45, 95% CI 1.27-1.65), and fair/poor health (OR 1.88, 95% CI 1.59-2.21) compared to LOCRC (Figure 1). Differences in healthcare access/utilization attenuated with adjustment but remained evident at the item level.

Conclusions: Compared with LOCRC, EOCRC survivors face greater psychosocial strain and more frequent financial and logistical barriers to care, even after adjustment. National patient-reported outcomes reveal gaps in care not captured in traditional registries, emphasizing the urgency of integrating supportive care and resource navigation into EOCRC management.

Learning Objectives:

Describe differences in patient-reported social support, discrimination, and health perceptions between early- and later-onset colorectal cancer using data from the All of Us Research Program.
Recognize financial and logistical barriers disproportionately affecting early-onset colorectal cancer survivors compared with later-onset counterparts.
Discuss how national patient-reported outcomes can identify psychosocial gaps not captured in traditional cancer registries and inform supportive care strategies for early-onset colorectal cancer.