COLORECTAL cancer incidence among adults below the age of 50 is rising globally. This population also presents with metastatic disease more frequently and has worse survival compared with older adults. However, the factors underlying the worse outcomes are unclear.
The research team hypothesised that several factors such as a lack of screening, and a reduced awareness of colorectal cancer in younger patients can result in treatment delays leading to advanced-stage diagnosis and poor outcomes. Thus, Matther Castelo, University of Toronto, Canada, and colleagues used linked population-based data to explore the potential association between time from presentation to treatment and survival in a young cohort.
The analysis included 5,026 patients (median age: 44 years; 52% male) aged 50 years or younger who were diagnosed with colorectal cancer between 2007–2018. Nearly one-third (31.2%) had rectal cancer and one-quarter had metastatic disease (25.2%). The median interval between presentation and treatment was 108 days (interquartile range: 55–214), with a decreased median interval among those with metastatic disease (83 days; interquartile range: 39–183).
Further analysis revealed a 5-year overall survival rate of 69.8% across the entire cohort (95% confidence interval [CI]: 68.4–71.1). However, younger patients with shorter intervals (<108 days) between presentation, and treatment had a poorer overall survival rate and cause-specific survival than patients with longer intervals. Finally, adjusted Cox models suggested that intervals over 18 weeks had no impact on overall survival (hazard ratio: 0.83; 95% CI: 0.67–1.03) and cause-specific survival (hazard ratio: 0.9; 95% CI: 0.69–1.18) compared with those with 12 –18-week intervals.
Overall, the duration between presentation and treatment did not impact outcomes for adults aged 50 or younger with colorectal cancer, suggesting that targeting post presentation intervals may not translate to improved outcomes. Castelo and colleagues concluded: “Our results suggest time to treatment is closely tied to disease stage at presentation and subsequent triage by physicians, and efforts to shorten this interval further are unlikely to result in meaningful improvements in survival for younger patients with [colorectal cancer] at the population level.”
