TOPLINE:
Longer time to treatment in younger patients with colorectal cancer (CRC) do not appear to be associated with worse survival, a new population-based study suggests.
METHODOLOGY:
This retrospective cohort study analyzed data from 5026 people younger than age 50 years who presented with symptoms of CRC before their official diagnosis.
Researchers determined the numbers of days between that initial presentation of symptoms and treatment initiation — the overall interval — and whether longer time to treatment was associated with worse survival.
To determine the date of first presentation, the authors used an algorithm based on administrative and billing codes, searching for the earliest clinical encounter for CRC-related symptoms as long as 18 months before their diagnosis.
Outcomes included overall survival (months from treatment to death or until December 31, 2019) and cause-specific survival (deaths from CRC or other causes).
The overall interval was divided into 6-week increments, with the reference group set at 12-18 weeks.
The authors also looked at a subgroup of 2548 lower-urgency patients who had no metastatic disease, or cross-sectional imaging or endoscopy within 14 days of first presentation.
TAKEAWAY:
The median overall interval was 108 days, with disease stage associated with time to treatment; patients with metastatic CRC had the shortest median overall intervals (83 days) while those with stage I CRC had the longest (152) and those with stage II and III were in the middle (108 and 107 days, respectively).
Younger adults with overall intervals shorter than the median, especially under 6 weeks, had worse overall survival, reflecting the faster time to treatment among patients with more advanced disease.
But when stratifying by cancer stage, longer overall interval was not associated with significantly worse overall survival; results were similar in the subset of lower-urgency patients with non-metastatic disease.
Compared with the reference group timeline (12-18 weeks), longer time to treatment of more than 18 weeks was not associated with significantly worse overall survival (hazard ratio [HR], 0.83) or cause-specific survival (HR, 0.90).
IN PRACTICE:
Consistent with previous studies on delays in treatment, the current study showed that “young patients with CRC with very short overall intervals disproportionately had metastatic disease, emergency presentations, and poor outcomes,” the authors write. Overall, this study highlighted that delays in treatment following symptom presentation “do not appear to drive advanced disease and poor outcomes in young adults.”
SOURCE:
The study, led Matthew Castelo, MD, of the University of Toronto, Canada, was published online August 3 in JAMA Network Open.
LIMITATIONS:
The date of first presentation was identified using a complex algorithm that has only previously been compared with patient charts for oral cancer. It is possible that young adults have delays to presentation that contribute to worse outcomes, a factor not accounted for in the current study. Delays in cancer care are known to be related to health behavior and psychological factors, which also were not incorporated in this analysis.
DISCLOSURES:
This study was supported by the Institute for Clinical Evaluative Sciences, and the Canadian Institutes of Health Research. The authors disclosed no relevant financial relationships, and no study funding was declared.
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