Analysis of early onset colorectal cancer: Implications for research and clinical practice.

Abstract

3606 Background: Young onset colorectal cancer(YOCRC), diagnosed < 50 years old, presents distinct challenges, including life transitions, and psychosocial needs. In Alberta, Canada an Adolescent and Young Adult(AYA) program was introduced at our tertiary cancer centres to address these unique needs through tailored resources and services. This study aimed to explore the YOCRC patients' adjuvant care experiences and describe resource utilization prior to and after the AYA program was established. Methods: A retrospective review of YOCRC patients diagnosed with StageIII disease from 2012-2022 and referred to Cancer Care Alberta for adjuvant therapy was performed. This study evaluated the adjuvant care experiences of YOCRC patients, focusing on demographics, tumor characteristics, toxicity, and psychosocial visits. Incidence rates over time was assessed using Joinpoint regression. The Edmonton Symptom Assessment System(ESAS) scores collected during treatment visits were used to characterize symptomatic concerns. Analysis included descriptive statistics and multivariate regression analysis. Results: Among 576 patients, the mean age at diagnosis was 42.9 years. There was a positive trend in incidence of diagnoses per year(p < 0.0001), with an increase in diagnosis of 3.96%(CI 1.30-7.13) per year in patients aged 40-49. Patients with stages IIIB disease were older at time of diagnosis compared to stage IIIC(p = 0.025). Higher stages had poorer outcomes with stage IIIA, IIIB and IIIC(p < 0.001), however median survival was not reached for any stages due to a low death rate. Patients reported psychological related symptoms(well-being, sleep problems and tiredness) more commonly than physical symptoms. Psychosocial visits increased after AYA program initiation with annual rates rising from 7.8 visits/year(pre-AYA program implementation) to 24 visits/year(post-AYA implementation). Further, patients who attended psychosocial visits were more likely to be younger(p < 0.001) and had higher overall mortality(p < 0.001). Of patients with an ESAS of ≥4, patients who were 40-49 were more likely to attend psychosocial service appointments than those aged 20-39, odds ratio of 3.23(95% CI: 1.28-8.78). There was no difference comparing patients attending psychosocial visits or higher ESAS score with sex or stage. Conclusions: Stage III YOCRC patients are increasing in Alberta. An AYA program can improve resource utilization, psychosocial support, and enhance visit frequency for this population with unique needs. Greater prominence of psychological symptoms on ESAS highlight areas that could benefit from focused resources for this population. Demographics of stage III YOCRC patients. Demographics n=576 Sex Male 320 Female 256 Site Colon 291 Rectum 245 Rectosigmoid 40 Stage (AJCC 7) IIIA 52 IIIB 348 IIIC 171 IIINOS 3 Incidence Year 2012 46 2013 40 2014 41 2015 55 2016 43 2017 50 2018 50 2019 61 2020 52 2021 64 2022 74