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Disparities exist in the outcomes of younger and older adults with colorectal cancer, which may be influenced by delays in treatment. Younger patients may have longer pre-diagnostic delays and present with more advanced disease than older patients, according to a recent study. 

The incidence of colorectal cancer in adults younger than 50 years has increased over the years. In addition, a 1% annual increase in mortality has occurred in younger adults with colorectal cancer from 2005 to 2017. By contrast, mortality in older adults with colorectal cancer has decreased by 3% each year. This disparity in mortality rates may be partially explained by delays in diagnosis and treatment in younger adults. These delays may be further complicated by the fact that younger patients may not be eligible for screening. 

Researchers conducted a systematic review of observational studies that compared delays in younger and older adults with colorectal cancer. Additionally, the researchers examined the differences in cancer outcomes due to delays in diagnosis and treatment, among other factors. A total of 39 studies were included in the review, comprising 185,710 younger patients and 1,422,062 older patients with colorectal cancer. 

Significantly longer delays were noted among younger adults. Adults younger than 50 years also had an increased likelihood of advanced stage cancer. All studies showed that younger adults experienced longer delays when examined at pre-diagnostic intervals. One study in the review found that longer delays were linked to an advanced stage and worse survival rates in younger adults compared to older adults. 

Younger patients may experience delays from symptom onset to presentation due to a lack of eligibility for screening, nonspecific initial symptoms, or alternative diagnoses, such as hemorrhoidal disease. However, more research is needed to determine appropriate modifiable patient, clinician, and system factors to target for intervention. 

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Source:

Castelo, M., Sue-Chue-Lam, C., Paszat, L., Scheer, A. S., Hansen, B. E., Kishibe, T., & Baxter, N. N. (2022). Clinical Delays and Comparative Outcomes in Younger and Older Adults with Colorectal Cancer: A Systematic Review. Curr Oncol, 29(11), 8609-8625. https://doi.org/10.3390/curroncol29110679