Jun H. Song, MD, Butros Toro, MD, Adam C. Ehrlich, MD, MPH, Jonathan Gotfried, MD; Temple University Hospital, Philadelphia, PA
Introduction: Early onset (age< 50) colorectal cancer (CRC) is increasing in incidence. Patients with early onset CRC typically develop symptoms prompting diagnostic evaluation. More severe symptoms may lead to inpatient hospitalization at presentation and undergo expedited diagnostic colonoscopy compared to outpatients with less pronounced symptoms. Outcomes from this potential discrepancy in diagnostic evaluation are not well described. We therefore sought to characterize outcomes of inpatients and outpatients who presented with early onset, symptomatic CRC diagnosed through colonoscopy. Methods: We retrospectively analyzed all patients age > 18 and < 50 diagnosed with CRC from 1/2011 – 12/2017 in our urban, academic, safety-net hospital. Data was obtained from our cancer institute’s registry. Patients were excluded if they were not diagnosed by colonoscopy. Patients were stratified based on setting (inpatient vs outpatient). Data was analyzed using Graphpad Prism. Results: Sixty-one patients met the inclusion criteria (Fig. 1). Forty patients were diagnosed as inpatients and twenty-one patients as outpatients. There was no demographic factor that predisposed diagnosis in the inpatient setting. There were no statistical differences in stage of CRC between cohorts (p = 0.167) (Fig. 2). Average time intervals from initial consultation with a gastroenterologist to diagnostic examination was 2.29 days and 34.83 days for inpatient and outpatient groups, respectively (p = 0.0001) (Fig. 3a). Average survival, as determined by last known date alive, was 3.38 years and 4.21 years for inpatient and outpatient groups, respectively (p = 0.2119) (Fig. 3b). There was no statistical difference in therapeutic modality for cancer treatment (p = 0.265). Discussion: We characterized outcomes in both inpatients and outpatients undergoing diagnostic colonoscopy after presenting with symptomatic, early onset CRC. Not surprisingly, the inpatients had significantly expedited colonoscopies than outpatients. This may be due to suspicion for more advanced disease in inpatients based on symptoms at presentation. However, there was no statistical difference in CRC stage between groups at time of diagnosis. Furthermore, performing urgent inpatient colonoscopy did not lead to a significant difference in survival or treatment type. These findings suggest electing for outpatient colonoscopy may not affect mortality rates compared to urgent inpatient procedures in symptomatic patients with early onset CRC.
Figure 1. Patient demographics
Figure 2. Stage of colorectal cancer in inpatient and outpatient cohorts. Pathological stage was used when available. When unavailable, clinical stage was used.
Figure 3. (A) Number of days from consultation to endoscopy and (B) length of survival
Disclosures: Jun Song indicated no relevant financial relationships. Butros Toro indicated no relevant financial relationships. Adam Ehrlich indicated no relevant financial relationships. Jonathan Gotfried indicated no relevant financial relationships.