P1319 - Presentation and Characteristics of Colorectal Cancer in Younger vs Older Patients in a Safety-Net System

Daniel M. Kim, BS¹, Ma Somsouk, MD, MS², Pooja Dharwadkar, MD^1
1University of California San Francisco, San Francisco, CA; ²UCSF, San Francisco, CA

Introduction: Early-onset colorectal cancer (eoCRC) has been associated with advanced disease, possibly affected by delays in presentation or diagnosis. We describe the clinical presentations and provider practices in younger (< 50 years) versus older patients to compare presenting symptoms, time to diagnosis, and stage at diagnosis.

Methods: We conducted a retrospective chart review of patients diagnosed with or treated for CRC between January 2010 and June 2020 in a safety-net hospital. Electronic medical records were manually reviewed for demographics, clinical presentation, days to diagnosis, and tumor characteristics. Primary analyses evaluated presenting symptoms, time to diagnosis, and staging. Secondary analyses include demographics and tumor characteristics.

Results: Of 509 patients, 71 (13.9%) were diagnosed before 50 years (median age 45, IQR 40-47.5) and 438 (86.1%) were diagnosed at or after 50 years (median age 62, IQR 56.3-68). Patients with eoCRC were more likely to be male (64.8% vs 56.4%), Hispanic (31% vs. 13.5%), and have a family history of CRC (19.7% vs 7.8%) compared to older patients. Younger patients also had higher proportions of rectal tumors (39.4% vs 28.5%), poorly-differentiated tumors (25.4% vs 8%), and advanced stage at diagnosis (73.2% vs 52%). These differences persisted in a sensitivity analysis excluding patients diagnosed by screening or surveillance. 98.6% of younger patients (n=70) and 78.3% of older patients (n=343) were symptomatic. Predominant symptoms for younger patients were hematochezia (41.4% vs 30.6%) and abdominal pain (17.1% vs 9%). Both groups similarly presented for complications of bowel obstruction or perforation (12.7% vs 12.3%). Fewer younger patients presented with iron deficiency anemia (11.2% vs 16.3%). Patients in both groups often presented to emergency departments for initial evaluation (48.6% vs 40.2%), but younger patients less often presented to primary care (21.4% vs 30.9%). Median time from presentation to diagnosis was slightly shorter in younger patients (16 vs 20 days).

Discussion: We found that time to diagnosis of CRC after symptomatic presentation was similar in younger and older patients. Younger patients were more likely to utilize urgent/emergent services, likely due to lack of established primary care. Importantly, despite similar times to diagnosis, younger patients had more advanced disease at diagnosis suggesting that tumor biology, rather than delays in diagnosis, may drive the unfavorable prognostic features in eoCRC.




Disclosures:


Daniel M. Kim, BS¹, Ma Somsouk, MD, MS², Pooja Dharwadkar, MD¹. P1319 - Presentation and Characteristics of Colorectal Cancer in Younger vs Older Patients in a Safety-Net System, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.