P2214 - Weight Loss as a Presenting Symptom of Colorectal Cancer Does Not Lead to an Expedited Colonoscopy but Is Associated With a Decreased Survival Rate

Jun Song, MD¹, Butros Toro, MD¹, Neil Sood, MD¹, Navneet Goraya, MD¹, Rebecca Moon, MD, MBA², Jonathan Gotfried, MD³, Adam C. Ehrlich, MD, MPH^4
1Temple University Hospital, Philadelphia, PA; ²Kaiser Permanente Los Angeles Medical Center, Philadelphia, PA; ³Bryn Mawr Hospital, Philadelphia, PA; ⁴Temple University, Philadelphia, PA

Introduction: Guidelines for endoscopic wait times (EWT), defined as the time between initial evaluation by a gastroenterologist to the time of endoscopy, are not well established. Investigating outcomes related to EWT is necessary to characterize how delays in endoscopy can affect patient care. We sought to study how EWT in colorectal cancer (CRC) diagnosis based on initial patient symptoms affects clinical outcomes.

Methods: We retrospectively analyzed patients age ≥18 years diagnosed with CRC from January 2011 to December 2017 in our urban, academic, safety-net hospital. Patients were excluded if they were not diagnosed via diagnostic colonoscopy. Patients were stratified based on initial symptoms at presentation which included abdominal pain, anemia, constipation, diarrhea, rectal bleeding, and weight loss.

Results: Two hundred and ninety-seven patients met the inclusion criteria (Table 1). For patients who reported and denied weight loss, average EWT were 2.1 months and 1.2 months, respectively (p=0.10) [Fig. 1A]. Those who reported weight loss had more advanced stage of cancer at diagnosis compared to those who denied weight loss (p< 0.01) [Fig. 1B]. By using the Cox proportional hazards model with age as a covariate for multivariate analysis, the average length of survival was found to be lower in patients who reported weight loss (p< 0.001, HR 2.1, 95% CI 1.3-3.1) [Fig. 1C]. Average times to treatment were 1.2 months in patients who reported weight loss and 1.4 months in those who denied weight loss (p=0.47). Complications after diagnosis including development of metastatic disease, deep vein thromboses, pulmonary embolisms, and obstructions were similar between the two cohorts.

Discussion: EWT was not significantly different between patients with and without weight loss; however, patients who reported weight loss were found to have higher rates of stage 3 and 4 cancers. This was associated with a significantly decreased survival rate. The time from diagnosis to treatment was not statistically significant. There were no significant associations between EWT and outcomes in those presenting with abdominal pain, anemia, constipation, diarrhea, and rectal bleeding. These results suggest that patients with weight loss as a symptom for CRC may benefit from earlier diagnostic endoscopies to identify earlier stage cancers. Further research is required to determine the optimal EWT in patients who present with weight loss as a symptom of their CRC and whether decreased EWT would impact survival rate.




Disclosures:


Jun Song, MD¹, Butros Toro, MD¹, Neil Sood, MD¹, Navneet Goraya, MD¹, Rebecca Moon, MD, MBA², Jonathan Gotfried, MD³, Adam C. Ehrlich, MD, MPH⁴. P2214 - Weight Loss as a Presenting Symptom of Colorectal Cancer Does Not Lead to an Expedited Colonoscopy but Is Associated With a Decreased Survival Rate, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.