Do treatment patterns differ in those with early-onset colorectal cancer?

ABSTRACT

Background

The incidence of early-onset colorectal cancer (EOCRC) is increasing. International guidelines state that treatment should not differ from that of older patients. Several studies have shown that patients under 50 years are receiving more aggressive treatment, without any survival benefit. We aim to determine if treatment for stages 2 and 3 EOCRC differs from those of late-onset colorectal cancer (LOCRC) patients.

Methods

This was a retrospective, population-based, cohort study of the treatment patterns of patients diagnosed with colorectal cancer in Canterbury, New Zealand, from 2010 to 2021 age <50 years, compared to those aged 60–74 years.

Results

A total of 3263 patients were diagnosed with CRC between 2010 and 2021. Following exclusions, we identified 130 EOCRC and 668 LOCRC patients. Stage 2 EOCRC patients are more likely to be offered adjuvant chemotherapy (p = <0.001). Furthermore, EOCRC patients with either stage 2 or 3 disease are more likely to receive multi-agent therapy (p =  <0.01), without any associated increase in survival.

Conclusion

EOCRC patients are given more adjuvant chemotherapy, without a corresponding improvement in outcomes, highlighting a potential for increased treatment-related harms, particularly in stage 2 disease. Clinicians should be mindful of these biases when treating young cancer patients and need to carefully consider treatment-related harms.

KEYWORDS:

• Early-onset colorectal cancer
• colorectal cancer
• colorectal surgery
• oncology
• bowel cancer
• chemotherapy
• radiotherapy

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

O Waddell and Y Teo were involved in every stage of the production of the manuscript. Y Teo and N Thompson were involved in data collection, analysis, and writing of the first draft. A McCombie was involved in data analysis and editing. T Glyn and F Frizelle were involved in conceptualization, methodology, and review and editing. All authors read and approved the final manuscript.

Acknowledgments

We would like to thank the NZCR for their time extracting data for us.

Additional information

Funding

This research was undertaken by Oliver Waddell as part of a full-time PhD, with the support of a Colorectal Surgical Society of Australia and New Zealand (CSSANZ) scholarship and a research grant from New Zealand Society of Gastroenterology (NZSG).