Symptom burden and time from symptom onset to cancer diagnosis in patients with early-onset colorectal cancer

• Published in: Canadian Journal of Surgery Vol. 65; pp. S79 - S80
• Main Authors: Baronas, Victoria, Arif, Arif, Ladua, Gale, Bhang, Eric, Brown, Carl, Donellan, Fergal, Stuart, Heather, Loree, Jonathan
• Format: Journal Article
• Language: English
• Published: Ottawa CMA Impact, Inc 01.11.2022
• Subjects: Colorectal cancer; Medical diagnosis
• ISSN: 0008-428X; 1488-2310

Background: The incidence of colorectal cancer (CRC) is decreasing in individuals aged > 50 years owing to organized screening. For younger individuals, however, the incidence has increased. Methods: We aimed to identify the pattern of presentation in young individuals and determine whether young patients may have delayed diagnosis despite symptoms that prompt investigation. Results: The average number of presenting symptoms in early-onset CRC (E°CRC) was 2.6 ± 1.4 v. 1.8 ± 1.5 in late-onset CRC (L°CRC) (p < 0.0001). In E°CRC, the time from symptom onset to cancer diagnosis was significantly longer at 169 ± 157 v. 128 ± 176 days in L°CRC (p < 0.0001). The number of symptoms at diagnosis was associated with worse overall survival (OS) in both E°CRC (p < 0.0001) and L°CRC (p < 0.0001) groups. E°CRC presenting with < 3 symptoms had improved OS v. L°CRC (5-yr OS 66% v. 37%, p < 0.0001). If presenting with > 4 symptoms, there was no difference in OS (5-yr OS 33% v. 30%, p = 0.49). Median survival for all E°CRC (96 mo) was significantly better than for L°CRC (47 mo) (hazard ratio [HR] 1.5, 95% confidence interval [CI] 1.4-1.7). The symptoms at presentation that predicted worse OS in E°CRC included ascites (HR 5.3, 95% CI 2.0-14) and night sweats (HR 3.5, 95% CI 1.9-6.6). In L°CRC, the symptoms that predicted worse survival were sacrococcygeal pain (HR 2.8, 95% CI 1.35.8) and anorexia (HR 2.2, 95% CI 1.6-3.0). Out of the E°CRC, 28% presented with metastatic disease compared with 23% in L°CRC (odds ratio 1.3, 95% CI 1.2-1.5). Conclusion: E°CRC who present with fewer symptoms have improved OS. However, their time to diagnosis is delayed and they present with more symptoms and at a later stage on average than L°CRC. Improvement in early detection of CRC in patients aged < 50 years would lead to a significant improvement in OS.