Disparities in Colorectal Cancer Presentation at a National Cancer Institute-Designated Cancer Center and a Safety-Net Hospital during the COVID-19 Pandemic

Abstract

Background: The clinical setting where patients with colorectal cancer (CRC), especially young adults, accessed the healthcare system during the COVID-19 pandemic to obtain their diagnosis is understudied. We hypothesized that patients with early-onset CRC (EO-CRC) present at disproportionate rates to emergency departments compared to patients with average-age onset CRC (AO-CRC). Patient and Methods: Clinical chart review was conducted for patients discussed at tumor board from the University of Texas Southwestern and Parkland Health Hospitals from August 2020 to August 2022 to compare the site of presentation that led to diagnosis: emergency department or primary care setting. Results: Two-hundred and ninety-three patients with CRC were included (69% AO-CRC, 31% EO-CRC), presenting at similar rates to primary care providers and emergency department (55% vs 45%, respectively). Most patients who presented to the emergency department received their cancer care at the safety net hospital (70%, p <0.001). Race/ethnicity, and comorbidities like obesity and metabolic dysregulation were also associated with emergency department presentation. Patients from the safety net hospital and those with obesity-related comorbidities were more likely present to the emergency department (OR 5.98, 95% CI 2.88 - 12.41, p<0.001; OR 4.18, 95% CI 1.18 - 14.81, p=0.03). Patients with rectal cancer are less likely to present to the emergency department (OR 0.42, 95% CI 0.21 - 0.85, p=0.02). No differences were observed between EO-CRC and AO-CRC with respect to the presentation site. Conclusion: Here we identified factors linked to CRC diagnostic access to the healthcare system during the COVID-19 pandemic in a racially and ethnically diverse population. Future research in this area can inform specialized CRC screening and diagnostic pathways for vulnerable young adults, guiding resource allocation to improve access to care and prompt diagnosis. Additionally, these insights can guide diagnostic access plans during global health crises for at-risk populations.