Symptom burden and time from symptom onset to cancer diagnosis in patients with early-onset colorectal cancer: a multicenter retrospective analysis

Abstract

Abstract Background The incidence of colorectal cancer (CRC) is decreasing in individuals > 50 years due to organised screening but has increased for younger individuals. We characterized symptoms and their timing before diagnosis in young individuals. Methods We identified all patients diagnosed with CRC between 1990–2017 in British Columbia, Canada. Individuals < 50 years (N = 2544, EoCRC) and a matched cohort > 50 (N = 2570, LoCRC) underwent chart review to identify CRC related symptoms at diagnosis and determine time from symptom onset to diagnosis. Results The most common symptoms at presentation for EoCRC and LoCRC are bloody stools (61.0% vs 40.2%, OR 2.3, 95%CI 2.1–2.6, p < 0.0001) and abdominal pain (51.8% vs 27.2%, OR 2.9, 95%CI 2.5–3.2, p < 0.0001). Across all stages of CRC, EoCRC presented with significantly more symptoms than LoCRC (Stage 1 mean ± SD: 1.3 ± 0.9 vs 0.7 ± 0.9, p = 0.0008; Stage 4: 3.3 ± 1.5 vs 2.3 ± 1.7, p < 0.0001). Greater symptom burden at diagnosis was associated with worse survival in both EoCRC (p < 0.0001) and LoCRC (p < 0.0001). The median time from symptom onset to cancer diagnosis was significantly longer for patients with EoCRC than LoCRC (143 days, 95%CI 134–154 vs 95 days, 95%CI 88–101, p < 0.0001). Despite this delay, survival for EoCRC presenting with a symptom duration > 6 months did not differ from those with shorter symptom duration (p = 0.58). When controlling for cancer stage, both age (HR 0.87, 95%CI 0.8-1.0, p = 0.008) and increasing symptom number were independently associated with worse survival in multivariate models. Conclusions Patients with EoCRC present with a greater number of symptoms of longer duration than LoCRC, however time from patient reported symptom onset was not associated with worse outcomes.