Symptom burden and unmet supportive care needs in a population-based sample of early-onset colorectal cancer survivors.

Abstract

658 Background: Despite the rising incidence of early-onset colorectal cancer (EOCRC), the long-term symptom burden and supportive care needs of this unique survivor group remain poorly characterized, hindering the development of targeted survivorship interventions. We evaluated symptom burden and unmet supportive care needs in a large, diverse population-based cohort of EOCRC survivors, and identified factors associated with greater unmet needs. Methods: Adults diagnosed under age 50 with stages I-III EOCRC in 2019-2023, as reported to the SEER registries in Georgia, Kentucky, and LA County, and treated with curative-intent surgery, were surveyed 1-5 years post-diagnosis (N=1282, 48% current response rate). Survivors reporting recurrence or second primaries were excluded (N=206). Participants were asked to report symptom frequency and bother across 5 domains (urinary, bowel, mental health, sexual health, and neuropathy). Within each domain, a summary score of symptom frequency was estimated (higher score reflects more severe symptoms, range 1-4), and symptom bother in the past month was categorized as sometimes/often/always (bothersome) vs. never/rarely (not bothersome). Participants were also asked to what extent their symptoms were being addressed by their health care providers for each domain, categorized as not at all/a little (unmet need) vs. moderately/mostly/completely (no unmet need). Multivariable-adjusted logistic regression was used to examine variation in unmet needs for each domain across sociodemographic and clinical factors, adjusting for symptom frequency and bother. Results: In this current sample of 1076 survivors, sexual dysfunction had the highest symptom frequency (mean 2.0, SD 0.9), followed by bowel symptoms (1.8, 0.8) and neuropathy (1.8, 0.9). Overall, 38% of survivors reported bothersome bowel symptoms, 25% reported bothersome mental health or neuropathy symptoms, and 14% reported bothersome urinary or sexual dysfunction symptoms. Amongst those reporting high symptom bother, more than half also reported unmet care needs within each symptom domain: 76% for sexual health, 67% for urinary, 57% for bowel, 55% for neuropathy, and 53% for mental health. Female survivors were more likely to report unmet care needs related to sexual health vs. male survivors (aOR: 1.65, 95% CI: 1.11-2.46). Hispanic survivors were more likely to report unmet care needs for mental health symptoms, compared to white survivors (aOR: 1.52, 95%CI: 1.03-2.24). Conclusions: EOCRC survivors experience ongoing symptom burden and frequently report unmet care needs, especially for sexual health, with disparities in unmet needs observed among female and Hispanic survivors. Tailoring survivorship care to identify and support these high-risk subgroups is essential to mitigate disparities and improve outcomes in this growing patient population.