{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T15:11:17Z","timestamp":1784214677224,"version":"3.55.0"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"\n Importance<\/jats:title>\n Incidence of early age\u2013onset colorectal cancer (EOCRC) is increasing. Delays in initiation of definitive therapy are associated with worse outcomes in colorectal cancer (CRC), but their impact on EOCRC has not been comprehensively characterized.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate incidence of EOCRC, identify patients affected by treatment delays, and determine targetable factors contributing to delayed therapy.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective, population-based cross-sectional study analyzed data from patients diagnosed with CRC from January 1, 2004, to December 31, 2019, using the Texas Cancer Registry. Patients were classified as having either EOCRC (diagnosed age &amp;lt;50 years) or average age\u2013onset colorectal cancer (AOCRC; diagnosed age \u226550 years). The data analysis was performed between August 2024 and November 2025.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The main outcomes were EOCRC status and treatment delays, defined as more than 6 weeks from tissue diagnosis to initiation of definitive therapy. Overall survival (OS), prevalence, impact of treatment delays, and patient-level and system-level factors associated with delayed treatment were also assessed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 112\u202f672 patients with CRC (overall mean [SD] age, 65.4 [13.5] years; 61\u202f570 [54.6%] male), 12\u202f079 (11%) had EOCRC, and 100\u202f593 (89%) had AOCRC. The cohort comprised 3111 Asian and Pacific Islander individuals (2.8%), 14\u202f517 Black individuals (12.9%), 23\u202f372 Hispanic individuals (20.7%), and 71\u202f672 White individuals (63.6%). Mean (SD) age for the EOCRC cohort was younger (41.6 [5.9] years) compared to the AOCRC cohort (68.2 [11.2] years;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Compared to patients with AOCRC, patients with EOCRC were less likely to be of White race (6421 [53.2%] vs 65\u202f251 [64.9%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and more likely to be of Hispanic ethnicity (3389 [28.1%] vs 19\u202f983 [19.9%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Median OS for patients with EOCRC was not reached compared to patients with AOCRC at 80 months (hazard ratio [HR], 0.56; 95% CI, 0.56-0.60;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). In multivariable analysis, higher Social Vulnerability Index (HR, 1.22; 95% CI, 1.19-1.26; P\u2009&amp;lt;\u2009.001) and treatment delays (HR, 1.29; 95% CI, 1.26-1.32; P\u2009&amp;lt;\u2009.001) were associated with worse OS. Median OS for patients with EOCRC was not reached in patients with or without treatment delay; however, it remained significant (HR, 1.35; 95% CI, 1.32-1.38; P\u2009&amp;lt;\u2009.001). After controlling for demographic and clinical factors, language barriers were associated with treatment delay in EOCRC (odds ratio, 1.45; 95% CI, 1.18-1.79; P\u2009&amp;lt;\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study, EOCRC was associated with improved OS compared with AOCRC; however, treatment delays were independently associated with worse survival among patients with EOCRC. Language barriers could be a potentially modifiable risk factor associated with delayed treatment and may provide an opportunity to improve timely care and outcomes in EOCRC.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoncol.2026.1335","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T15:30:25Z","timestamp":1780587025000},"page":"722","source":"Crossref","is-referenced-by-count":0,"title":["Treatment Delays in Early Age\u2013Onset Colorectal Cancer"],"prefix":"10.1001","volume":"12","author":[{"given":"Ryan T.","family":"Heslin","sequence":"first","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary A.","family":"Whitham","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan F.","family":"Pettigrew","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert Z.","family":"Murimwa","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren A.","family":"Tyler","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah W.","family":"Ding","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical School, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R.","family":"Porembka","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricio M.","family":"Polanco","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Herbert J.","family":"Zeh","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam C.","family":"Yopp","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia G.","family":"Ethun","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"},{"name":"Now with RWJBarnabas Health Medical Group, Cancer Surgery Services, Department of Surgery, Livingston, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam C.","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex C.","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"coi260020r1","first-page":"12","article-title":"Cancer statistics, 2024.","volume":"74","author":"Siegel","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"3","key":"coi260020r2","first-page":"233","article-title":"Colorectal cancer statistics, 2023.","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J Clin"},{"issue":"20","key":"coi260020r3","doi-asserted-by":"publisher","first-page":"5953","DOI":"10.7150\/jca.46661","article-title":"Colonoscopic screening is associated with reduced colorectal cancer incidence and mortality: a systematic review and meta-analysis.","volume":"11","author":"Zhang","year":"2020","journal-title":"J Cancer"},{"issue":"12","key":"coi260020r4","doi-asserted-by":"publisher","first-page":"3362","DOI":"10.1158\/1055-9965.EPI-09-0661","article-title":"The association between cigarette smoking and risk of colorectal cancer in a large prospective cohort from the United States.","volume":"18","author":"Hannan","year":"2009","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"6","key":"coi260020r5","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1158\/1055-9965.EPI-09-0186","article-title":"Increase in incidence of colorectal cancer among young men and women in the United States.","volume":"18","author":"Siegel","year":"2009","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"1","key":"coi260020r6","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1186\/s12876-025-04086-5","article-title":"Global burden, trends, and risk factors of early-onset and late-onset colorectal cancer from 1990 to 2021, with projections to 2040: a population-based study.","volume":"25","author":"Pan","year":"2025","journal-title":"BMC Gastroenterol"},{"issue":"12","key":"coi260020r7","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1093\/jnci\/djab124","article-title":"A comprehensive comparison of early-onset and average-onset colorectal cancers.","volume":"113","author":"Cercek","year":"2021","journal-title":"J Natl Cancer Inst"},{"issue":"12","key":"coi260020r8","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1093\/jnci\/djab123","article-title":"Clinicopathological and molecular characteristics of early-onset stage III colon adenocarcinoma: an analysis of the ACCENT database.","volume":"113","author":"Jin","year":"2021","journal-title":"J Natl Cancer Inst"},{"key":"coi260020r9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1200\/EDBK_350241","article-title":"Early-onset colorectal cancer survival differences and potential geographic determinants among men and women in Utah.","volume":"42","author":"Rogers","year":"2022","journal-title":"Am Soc Clin Oncol Educ Book"},{"issue":"3","key":"coi260020r10","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1016\/j.surg.2024.05.031","article-title":"Low neighborhood socioeconomic status is associated with poor outcomes in young adults with colorectal cancer.","volume":"176","author":"Ko","year":"2024","journal-title":"Surgery"},{"issue":"6","key":"coi260020r11","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1097\/SLA.0000000000003745","article-title":"Time to surgery and colon cancer survival in the United States.","volume":"274","author":"Kaltenmeier","year":"2021","journal-title":"Ann Surg"},{"key":"coi260020r12","doi-asserted-by":"publisher","first-page":"m4087","DOI":"10.1136\/bmj.m4087","article-title":"Mortality due to cancer treatment delay: systematic review and meta-analysis.","volume":"371","author":"Hanna","year":"2020","journal-title":"BMJ"},{"issue":"15","key":"coi260020r13","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.024414","article-title":"Association between Social Vulnerability Index and cardiovascular disease: a behavioral risk factor surveillance system study.","volume":"11","author":"Jain","year":"2022","journal-title":"J Am Heart Assoc"},{"issue":"6","key":"coi260020r14","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1097\/SLA.0000000000006282","article-title":"Defining the role of social vulnerability in the treatment and survival of localized colon cancer: a retrospective cohort study.","volume":"281","author":"Meier","year":"2025","journal-title":"Ann Surg"},{"issue":"3","key":"coi260020r16","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.ejso.2019.11.513","article-title":"Impact of delay to surgery on survival in stage I-III colon cancer.","volume":"46","author":"Grass","year":"2020","journal-title":"Eur J Surg Oncol"},{"issue":"4","key":"coi260020r17","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1097\/SLA.0000000000006846","article-title":"Association of traditional and new surgical wait time targets and survival for curative-intent colorectal cancer surgery: a population-based cohort study.","volume":"282","author":"Bondzi-Simpson","year":"2025","journal-title":"Ann Surg"},{"issue":"4","key":"coi260020r18","doi-asserted-by":"publisher","first-page":"1394","DOI":"10.1053\/j.gastro.2020.10.010","article-title":"Race, ethnicity, and socioeconomic status are associated with prolonged time to treatment after a diagnosis of colorectal cancer: a large population-based study.","volume":"160","author":"Bui","year":"2021","journal-title":"Gastroenterology"},{"key":"coi260020r19","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1327400","article-title":"Disparities in time to treatment initiation for rectal cancer patients: an analysis of demographic and socioeconomic factors.","volume":"14","author":"Popp","year":"2024","journal-title":"Front Oncol"},{"key":"coi260020r20","doi-asserted-by":"publisher","DOI":"10.1177\/10732748211056692","article-title":"Risk factors for the diagnosis of colorectal cancer.","volume":"29","author":"Lewandowska","year":"2022","journal-title":"Cancer Control"},{"issue":"9","key":"coi260020r21","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.3390\/cancers13092025","article-title":"A review of colorectal cancer in terms of epidemiology, risk factors, development, symptoms, and diagnosis.","volume":"13","author":"Sawicki","year":"2021","journal-title":"Cancers (Basel)"},{"issue":"11","key":"coi260020r22","doi-asserted-by":"publisher","first-page":"1930","DOI":"10.1002\/ijc.34887","article-title":"Environmental drivers of the rising incidence of early-onset colorectal cancer in the United States.","volume":"154","author":"Chen","year":"2024","journal-title":"Int J Cancer"},{"issue":"6","key":"coi260020r23","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.12539","article-title":"Analysis of survival among adults with early-onset colorectal cancer in the National Cancer Database.","volume":"4","author":"Cheng","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"6","key":"coi260020r24","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1002\/cncr.29716","article-title":"Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening.","volume":"122","author":"Abdelsattar","year":"2016","journal-title":"Cancer"},{"issue":"6","key":"coi260020r25","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1097\/01.coc.0000437899.28701.03","article-title":"Clinicopathologic features and outcome of young adults with stage IV colorectal cancer.","volume":"38","author":"Hawk","year":"2015","journal-title":"Am J Clin Oncol"},{"issue":"17","key":"coi260020r26","doi-asserted-by":"publisher","first-page":"3510","DOI":"10.1002\/cncr.31527","article-title":"Rectal cancer patients younger than 50 years lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease.","volume":"124","author":"Kolarich","year":"2018","journal-title":"Cancer"},{"issue":"19","key":"coi260020r27","doi-asserted-by":"publisher","first-page":"2334","DOI":"10.1200\/JCO.2011.41.1975","article-title":"Benefits and adverse events in younger versus older patients receiving adjuvant chemotherapy for colon cancer: findings from the Adjuvant Colon Cancer Endpoints data set.","volume":"30","author":"Hubbard","year":"2012","journal-title":"J Clin Oncol"},{"issue":"20","key":"coi260020r28","doi-asserted-by":"publisher","first-page":"2781","DOI":"10.1200\/JCO.2010.33.5281","article-title":"Impact of young age on treatment efficacy and safety in advanced colorectal cancer: a pooled analysis of patients from nine first-line phase III chemotherapy trials.","volume":"29","author":"Blanke","year":"2011","journal-title":"J Clin Oncol"},{"issue":"9","key":"coi260020r29","doi-asserted-by":"publisher","first-page":"2469","DOI":"10.1245\/s10434-011-1674-7","article-title":"Young-onset rectal cancer: presentation, pattern of care and long-term oncologic outcomes compared to a matched older-onset cohort.","volume":"18","author":"You","year":"2011","journal-title":"Ann Surg Oncol"},{"issue":"5","key":"coi260020r30","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1001\/jamasurg.2014.3572","article-title":"Overtreatment of young adults with colon cancer: more intense treatments with unmatched survival gains.","volume":"150","author":"Kneuertz","year":"2015","journal-title":"JAMA Surg"},{"issue":"5","key":"coi260020r31","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1001\/jamasurg.2016.5050","article-title":"Chemotherapy use and survival among young and middle-aged patients with colon cancer.","volume":"152","author":"Manjelievskaia","year":"2017","journal-title":"JAMA Surg"},{"issue":"4","key":"coi260020r32","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/j.jnma.2022.04.001","article-title":"Racial and ethnic disparities in incidence and mortality for the five most common gastrointestinal cancers in the United States.","volume":"114","author":"Bui","year":"2022","journal-title":"J Natl Med Assoc"},{"issue":"6","key":"coi260020r33","doi-asserted-by":"publisher","first-page":"3793","DOI":"10.1007\/s40615-024-02178-8","article-title":"Unveiling disparities: analyzing Hispanic inclusion in liver cancer research databases in the United States.","volume":"12","author":"Figueroa","year":"2025","journal-title":"J Racial Ethn Health Disparities"},{"issue":"6","key":"coi260020r34","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1007\/s10552-007-9000-1","article-title":"Incidence of esophageal and gastric cancers among Hispanics, non-Hispanic whites and non-Hispanic blacks in the United States: subsite and histology differences.","volume":"18","author":"Wu","year":"2007","journal-title":"Cancer Causes Control"},{"issue":"2","key":"coi260020r35","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1158\/1940-6207.CAPR-11-0447","article-title":"A review of cancer in U.S. Hispanic populations.","volume":"5","author":"Haile","year":"2012","journal-title":"Cancer Prev Res (Phila)"},{"issue":"6","key":"coi260020r36","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.1007\/s10620-018-5012-9","article-title":"An investigation into the recent increase in gastric cancer in the USA.","volume":"63","author":"Balakrishnan","year":"2018","journal-title":"Dig Dis Sci"},{"issue":"11","key":"coi260020r37","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.46820","article-title":"Racial and ethnic variation in survival in early-onset colorectal cancer.","volume":"7","author":"Demb","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"8","key":"coi260020r38","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.70851","article-title":"Disparities in colorectal cancer incidence trends among Hispanics living in Puerto Rico (2000-2021): a comparison with Surveillance, Epidemiology, and End Results (SEER) database.","volume":"14","author":"Borrero-Garcia","year":"2025","journal-title":"Cancer Med"},{"issue":"6","key":"coi260020r39","doi-asserted-by":"publisher","first-page":"2080","DOI":"10.1002\/cam4.3811","article-title":"Racial\/ethnic disparities in early-onset colorectal cancer: implications for a racial\/ethnic-specific screening strategy.","volume":"10","author":"Acuna-Villaorduna","year":"2021","journal-title":"Cancer Med"},{"issue":"4","key":"coi260020r40","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/j.clcc.2017.06.002","article-title":"Early-onset colorectal cancer is distinct from traditional colorectal cancer.","volume":"16","author":"Yeo","year":"2017","journal-title":"Clin Colorectal Cancer"},{"issue":"8","key":"coi260020r42","doi-asserted-by":"publisher","first-page":"808","DOI":"10.4251\/wjgo.v12.i8.808","article-title":"Early stage colon cancer: Current treatment standards, evolving paradigms, and future directions.","volume":"12","author":"Chakrabarti","year":"2020","journal-title":"World J Gastrointest Oncol"},{"issue":"6","key":"coi260020r43","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1038\/s41416-023-02377-w","article-title":"The effect of time before diagnosis and treatment on colorectal cancer outcomes: systematic review and dose-response meta-analysis.","volume":"129","author":"Drosdowsky","year":"2023","journal-title":"Br J Cancer"},{"issue":"3","key":"coi260020r44","doi-asserted-by":"publisher","first-page":"5337","DOI":"10.1007\/s11357-025-01648-z","article-title":"Treatment delay significantly increases mortality in colorectal cancer: a meta-analysis.","volume":"47","author":"Ungvari","year":"2025","journal-title":"Geroscience"},{"issue":"1","key":"coi260020r45","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1186\/s12913-021-06750-4","article-title":"Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study.","volume":"21","author":"Pandey","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"coi260020r46","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1186\/s12939-017-0694-8","article-title":"Healthcare access for refugee women with limited literacy: layers of disadvantage.","volume":"16","author":"Floyd","year":"2017","journal-title":"Int J Equity Health"},{"issue":"5","key":"coi260020r47","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1097\/MOP.0000000000000404","article-title":"Lost in translation: impact of language barriers on children\u2019s healthcare.","volume":"28","author":"Goenka","year":"2016","journal-title":"Curr Opin Pediatr"},{"issue":"1","key":"coi260020r48","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1177\/2374373518769008","article-title":"Impact of language barriers on quality of care and patient safety for official language minority Francophones in Canada.","volume":"6","author":"de Moissac","year":"2019","journal-title":"J Patient Exp"},{"issue":"1","key":"coi260020r49","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s10995-007-0213-4","article-title":"\u201cThey can\u2019t understand it\u201d: maternity health and care needs of immigrant Muslim women in St. John\u2019s, Newfoundland.","volume":"12","author":"Reitmanova","year":"2008","journal-title":"Matern Child Health J"},{"key":"coi260020r50","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.ijnurstu.2015.03.012","article-title":"Language barriers and patient safety risks in hospital care: a mixed methods study.","volume":"54","author":"van Rosse","year":"2016","journal-title":"Int J Nurs Stud"},{"key":"coi260020r15","unstructured":"National Cancer Institute. Early-Onset Colorectal Cancer Think Tank. Updated May 18, 2022. Accessed February 27, 2026. https:\/\/www.cancer.gov\/about-nci\/organization\/dcb\/news\/early-onset-crc"},{"key":"coi260020r41","unstructured":"US Census Bureau. QuickFacts. 2024. Accessed February 27, 2026. https:\/\/www.census.gov\/quickfacts\/fact\/table\/US\/PST045224"}],"container-title":["JAMA Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/articlepdf\/2849979\/jamaoncology_heslin_2026_oi_260020_1784081564.56821.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T15:01:03Z","timestamp":1784214063000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/fullarticle\/2849979"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":50,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoncol.2026.1335","relation":{},"ISSN":["2374-2437"],"issn-type":[{"value":"2374-2437","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7,1]]}}}