Impact of Dedicated Care Coordination on Access to Multidimensional Support Services in Young-Onset Colorectal Cancer: A Pragmatic Trial

PURPOSE The incidence of young-onset colorectal cancer is increasing, and affected patients experience distinct challenges. Patients with young-onset colorectal cancer may benefit from a dedicated care coordinator who systematically assesses their unmet needs and facilitates referrals to multidimensional specialty support services. METHODS In this pragmatic trial, we assigned patients with newly diagnosed colorectal cancer younger than 50 years who presented to a tertiary academic institution between 2023 and 2025 to standard care versus standard care plus additional encounter(s) with a dedicated young-onset colorectal cancer care coordinator. Patient-reported concerns and distress were collected at initial presentation. The primary end point was utilization frequency of support services. Multivariable regression identified predictors of service utilization. RESULTS Among 1,250 patients with young-onset colorectal cancer (mean age 42.8 ± 6.0 years; 45.4% female), 46.3% had rectal cancer. Emotional concerns were most common (41.0%), followed by physical (36.1%), practical (27.8%), and social (9.4%) concerns. Overall, clinically significant distress (distress score ≥4) was reported by 27.4%. The young-onset colorectal cancer coordinator successfully established contact with 604 individuals. Unmet service needs were reported by 39.1% in the intervention group, of whom 80.5% subsequently accessed corresponding support services. Patients who established contact with the young-onset colorectal cancer coordinator were more likely to access support services (72.5% v 44.7%, P < .001). On multivariable analysis, coordinator contact (adjusted odds ratios [aOR], 1.48, 95% CI, 1.22 to 1.80), rectal cancer diagnosis (aOR, 1.36, 95% CI, 1.13 to 1.62), and clinically significant distress (aOR, 1.23, 95% CI, 1.01 to 1.50) predicted greater multidimensional service utilization. CONCLUSION Patients with young-onset colorectal cancer experience substantial emotional concerns and unmet needs. Proactive integration of a dedicated care coordinator was associated with significantly increased utilization of multidimensional support services. This pragmatic trial supports a personalized, needs-driven care delivery model that integrates patient-reported outcomes as the basis for patient-centric cancer care.