(P010) MISSED OPPORTUNITIES FOR PREVENTING COLORECTAL CANCER IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN AN URBAN SAFETY-NET HEALTH SYSTEM: CASE SERIES

Introduction:
Inflammatory bowel disease (IBD) increases the risk of colorectal cancer (CRC). This study aimed to assess the burden of CRC among IBD patients within a large urban safety-net health system and to identify potential missed opportunities for CRC prevention.

Methods:
We retrospectively reviewed electronic medical records of patients ages 18 and older treated at an urban safety-net health system from January 2010 to February 2024. Patients were included if they: 1) had diagnoses of both IBD and CRC, identified using ICD codes; and 2) had undergone at least one colonoscopy during the study period. We evaluated healthcare utilization, IBD and CRC characteristics, and treatment history.

Results:
Fifteen patients met the inclusion criteria (9 with ulcerative colitis, 5 with Crohn’s disease, and 1 with indeterminate colitis). Demographic characteristics included: 33.3% female, 66.7% male, 40% Black, 60% White, 33.3% Hispanic and 66.7% Non-Hispanic. Seven patients (46.7%) received healthcare services through a county-hospital financial assistance program (income ≤250% federal poverty level) and five (33.3%) through Medicaid. Most (86.7%) had a pre-existing diagnosis of IBD prior to CRC diagnosis, while 13.3% had IBD and CRC diagnosed concurrently. The median time from IBD diagnosis to CRC development was 17 years (IQR 8 to 20 years) and from the last endoscopic evaluation to CRC diagnosis was 3 years (IQR 1 to 9.5 years). At CRC diagnosis, 46.7% of patients had stage 4 cancer. Sixty percent had not seen a primary care provider or gastroenterologist within the past year before CRC diagnosis. Of those with known IBD, 61.5% were on an IBD-related therapy at diagnosis, but only 23.1% were receiving advanced therapies. Financial barriers (38.5%) were a documented cause of therapy interruption or delayed follow-up. Forty percent were in clinical remission, but only one patient was in endoscopic and histologic remission at the time of CRC diagnosis. Additionally, 13.3% had a concurrent diagnosis of primary sclerosing cholangitis, and 13.3% had a family history of CRC. Two patients had been previously diagnosed with high-grade dysplasia, with an average interval of 18 months between dysplasia and adenocarcinoma diagnoses. There were 9 (60%) deceased patients; overall survival ranged from 1 to 137 months (median: 9 months).

Conclusion:
Gastroenterology follow up, advanced therapeutics, and timely disease activity monitoring were infrequent among IBD patients who developed CRC. Low-income and minority patients faced significant care burden due to financial barriers and limitations in IBD treatment and CRC surveillance. Additional efforts to leverage culturally competent outreach to underserved IBD patients may improve care delivery for these vulnerable populations.