Background: Despite the increasing trends in early-onset colorectal cancer (EoCRC), little is known about EoCRC burden among Asian American and Pacific Islander (AAPI) populations. AAPI represents the fastest-growing U.S. racial group, underscoring the need to address this knowledge gap. This study aims to assess the patterns of characteristics and treatment of EoCRC among AAPI individuals, offering valuable insights that can potentially guide clinicians in refining screening strategies and treatment approaches within this burgeoning population.

Methods: We assessed the patterns of characteristics and treatment of EoCRC using data from the 2020 National Cancer Database (NCDB), accounting for 70% of all newly diagnosed cancer cases in the U.S. EoCRC cases diagnosed between 2010 and 2020 were identified using ICD-O-3 codes and age diagnosis (<50 years old). Study participants were disaggregated based on distributions and geographically relevant subpopulations: Chinese, Japanese, Korean, Filipino, Vietnamese, Asian Indian/Pakistani, Hawaiian, Southeast Asians, Pacific Islanders, and Other Asians. We used descriptive statistics and bivariate analysis to compare clinical characteristics (stage, histology), receipt of treatment (surgery, immunotherapy), and time to treatment since diagnosis.

Results: A total of 5506 AAPI patients diagnosed with EoCRC (mean age: 41.4 years old, 49% female, 23.8% stage IV) were included. Pacific Islanders had a mean diagnosis age of 39.7 years and a higher percentage of advanced stage III/IV (62.8%) compared to Koreans who had a lower percentage of advanced stage (54.4%) and a mean diagnosis age of 42.9 years (Table). Hawaiians had a higher proportion of colon cancer cases (71.2%) while rectal cancer was more prevalent among Filipinos (43.1%). The median time to the first cancer treatment was the lowest among Japanese (11 days) and highest among Pacific Islanders (20 days) (Figure). Among EoCRC patients with advanced stages, Southeast Asians had the longest median time to definitive surgery (29 days), while Vietnamese had the shortest (10 days). Mismatch repair (MMR) testing was performed in only 26.6% of AAPI patients with EoCRC, and only 49.3% of immunotherapy appeared to be guided by MMR testing (dMMR/MSI-H).

Conclusions: There were differences in clinical characteristics and treatment patterns of EoCRC between AAPI subgroups. Compared with East Asians, Southeast Asians or Pacific Islanders had a longer median time for cancer treatment. Continued improvement in data disaggregation can provide more insights into these disparities among AAPI populations, helping optimize time-to-treatment and guideline-concordance care for AAPI with EoCRC.

Sample and Tumor Characteristics, and Treatment Patterns

Time to Treatment Initiation After Diagnosis

Jiamin Hu

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