Quality of life in early-onset colorectal cancer patients: systematic review

Clinical challenges and patient experiences in early-onset colorectal cancer: insights from seven European countries

BACKGROUND

The incidence of early-onset colorectal cancer (eoCRC), defined as CRC diagnosed in individuals under 50, is rising globally. Younger patients often face diagnostic delays and receive care pathways designed for older populations. These gaps highlight the need for tailored approaches to diagnosis, treatment, and support.

OBJECTIVE

This study aimed to explore the lived experiences and challenges of eoCRC patients across seven European countries to inform public health strategies and improve patient-centered care.

METHODS

We conducted qualitative focus groups with 47 eoCRC patients and survivors from France, Ireland, Italy, the Netherlands, Romania, Spain, and the United Kingdom. Discussions were analyzed using a thematic approach, focusing on three stages of the patient journey: pre-diagnosis, diagnosis, and post-diagnosis.

RESULTS

Participants highlighted several key challenges, including low awareness of CRC symptoms among younger populations, diagnostic delays linked to age and gender biases, and limited access to age-appropriate support services. Many participants reported significant quality-of-life (QoL) impacts related to disrupted careers, intimacy issues, and challenges managing family responsibilities during treatment. Psychological support, physiotherapy, and nutritional counseling were inconsistently available, with significant disparities across public and private healthcare systems.

CONCLUSIONS

The findings underscore the urgent need for targeted public health campaigns to raise awareness of eoCRC, improved training for healthcare providers to reduce diagnostic delays, and expanded access to tailored support services. Addressing these gaps is critical to mitigating the growing burden of eoCRC and improving outcomes for younger patients.

The Unique Needs and Challenges of Young Females After Spontaneous Coronary Artery Dissection

PURPOSE

Spontaneous coronary artery dissection (SCAD) disproportionately affects females who are often younger in age. Age-based comparisons of the post-SCAD experience are required to adequately inform rehabilitation programming that is sensitive to patient life circumstances and needs. This multi-site qualitative study investigated the experiences of SCAD in females analyzed according to their age (<50 and ≥50 years).

METHODS

Females who had experienced a SCAD event were recruited from 5 large tertiary care hospitals. Participants completed sociodemographic and medical questionnaires and took part in a semi-structured interview. Transcribed data were subject to the framework method using deductive coding. Constructed codes and overarching themes were then compared in the <50 and ≥50-year patient groups. Themes that highlighted the central differences between demographic groups were then constructed inductively.

RESULTS

Overall, females with SCAD (n = 77; mean age = 52.9 ± 10.8 years; range = 29-77) reported struggling with a lack of information from their health care team with regards to the diagnosis, management, and long-term prognosis of SCAD. Younger patient (n = 32; mean age = 40.2 ± 6.7 years) transcripts evidenced more prominent themes of uncertainty, dissatisfaction with cardiac rehabilitation programming, difficulty adjusting to lifestyle and vocational changes, and family-related distress in comparison to those over 50 (n = 45; mean age = 57.8 ± 6.9 years).

CONCLUSIONS

Females with SCAD who are <50 years old appear to experience their recovery from SCAD differently than those who are older in age. These differences suggest that tailored approaches may be required in cardiovascular rehabilitation programming for younger SCAD patients.

Does adjuvant chemotherapy result in poorer health-related quality of life among colorectal cancer patients? A longitudinal multisite observational study in Singapore

BACKGROUND

Research on health-related quality of life (HRQOL) using minimally important differences for cancer care in Asian settings are sparse. This study aimed to describe functional HRQOL trajectories among Colorectal Cancer (CRC) patients undergoing adjuvant chemotherapy (AC) compared to those who did not (No AC), evaluate if AC was associated with change in HRQOL prospectively, and examine QOL differences between elderly and non-elderly CRC patients requiring AC.

METHODS

CRC patients diagnosed between February 2018 to August 2021 were recruited from three Singapore public hospitals. Participants completed the EORTC QLQ-C30 over seven timepoints (diagnosis, predischarge, 1-, 3-, 6-, 9-, 12-months post-surgery). Clinical characteristics were collected from electronic medical records.

RESULTS

The sample comprised 251 participants (102 in AC group; 40.64%). Clinically relevant deteriorations in functional HRQOL were observed in both groups between baseline and predischarge. These returned to baseline by 12-month. AC was associated with poorer physical (β = -35.34, p < 0.05) and role functioning (β = -71.17, p < 0.05) over time. Being elderly was associated with poorer physical functioning (β = -0.44, p < 0.05) over time. However, the non-elderly AC subgroup tended to experience poorer HRQOL in general compared to elderly.

CONCLUSIONS

Functional recovery remains a challenge for CRC patients in general. However, non-elderly AC patients may experience more severe impacts to role and social functioning.

Understanding the impact of early onset colorectal cancer on quality of life: a qualitative analysis of online forum data

PURPOSE

Early onset colorectal cancer (EOCRC) is rising. The profile of health-related quality of life (HRQOL) impacts may differ in this younger cohort. Online forums are a source of unfiltered information regarding patient experience. This study used a qualitative analysis of online forum messages to elicit the unique HRQOL impacts of EOCRC.

METHODS

Messages were extracted from an online EOCRC UK forum. Inductive coding (with 10% dual-coding) and thematic analysis were used to describe the impact of diagnosis and treatment on HRQOL.

RESULTS

Data extraction and analyses were performed over one month; 463 messages (dated 01/04/2019 to 31/03/2024) were included. There was 100% concordance on dual-coding for main themes. Eight themes emerged: (1) diagnostic pathway and barriers; (2) parenthood and effect on children; (3) employment and finances; (4) fertility and early menopause; (5) stoma implications; (6) support systems, relationships and isolation; (7) sport and exercise and (8) mental health.

CONCLUSIONS

Qualitative thematic analysis of online forum data is a novel and efficient methodology for understanding the impact of cancer on HRQOL. Identified themes overlapped with those published in previous systematic reviews. This study offers new insights into the impact of isolation, early menopause, benefits of parenthood, psychological impact on children and practical and psychological implications of potential infertility in EOCRC. Current understanding of the diagnostic challenges and unique HRQOL impacts of EOCRC raises future research questions regarding how colorectal cancer services should evolve to provide support more in keeping with the needs of this growing younger cohort.

Supervised Home-Based Exercise Intervention in Colorectal Cancer Patients Following Surgery: A Feasibility Study

This pilot study aimed to assess the feasibility and preliminary effects of a supervised, home-based exercise program in patients recovering from laparoscopic colorectal cancer surgery. A total of 23 patients were included, with 13 participating in the exercise intervention and 10 receiving standard postoperative care. The exercise group (intervention group) followed a two-month structured program, while the control group received no structured exercise. Feasibility was demonstrated by 98% adherence in the intervention group and no reported adverse events. At T1, the intervention group showed significant improvements in role function, cognitive function, and reduced fatigue compared to the control group. At T2, a significant difference was observed in physical function. Functional capacity, assessed by the Six-Minute Walk Test, was significantly better in the intervention group at T1, T2, and T3, as was physical performance measured by the Short Physical Performance Battery (SPPB) at T1, T2, and T3. No significant differences were observed between the groups in anxiety, depression, sleep quality, or body composition parameters. This study highlights the feasibility of a supervised home-based exercise program in the early postoperative phase, demonstrating positive effects on Quality of Life, functional recovery, and fatigue in colorectal cancer patients.

Factors associated with erectile dysfunction in traumatic urethral strictures following epa urethroplasty: a single center experience

INTRODUCTION

Urethral repair with Excision and Primary Anastomosis (EPA) urethroplasty offers excellent outcome in managing traumatic urethral strictures. However, its impact on erectile function (EF) is largely unknown. Study to evaluate EF outcome post-operatively is still limited worldwide. We report factors associated to EF following EPA Urethroplasty performed by single surgeon in tertiary hospital. In this study, we aim to evaluate the risk of erectile dysfunction (ED) following EPA Urethroplasty.

MATERIALS AND METHODS

This is a retrospective study on patients with traumatic urethral strictures who underwent EPA Urethroplasty from 2013 to 2023. Variables including age, body mass index, systemic disease, etiology, stricture length, prior procedures and erection hardness score (EHS) score prior and 12 months after surgery were recorded. Pre-Operative ED was determined using Penile Doppler Ultrasound, which was defined as a peak systolic velocity of less than 25 cm/s. Univariate and Multivariate logistic regression analysis were performed using IBM SPSS Statistic.

RESULTS

A total of 89 patients were included. Among them, 33 patients (33.7%) suffered from initial ED prior to surgery. Pelvic fracture urethral injury (PFUI) was the predominant etiology (74%); 29% of the patients were active smokers, and 68.5% had prior endoscopic treatment. Among the 48 patients without ED prior to surgery, 7 of them (14.6%) developed ED following surgery in 12 months of follow up. After EPA, there was a reduction of mean EHS score from 2.70 to 2.53 (p=0.176). Multivariate analysis showed that smoking status (p=0.035; OR 4.41), PFUI as the mechanism of injury (p=0.007; OR 2.89), prior urethrotomy (p=0.020; OR 4.69), and prior dilatations (p=0.046; OR 0.18) were related as risk factors of ED following EPA urethroplasty.

CONCLUSIONS

Risk of ED following EPA is inevitable, although the number is not as high as expected. Smoking, PFUI and prior treatment rather than EPA, emerge as predominant risk factors associated with the development of ED subsequent to surgical repair.

Treatment patterns in metastatic early-onset rectal cancer

BACKGROUND

Early onset rectal cancer (EORC) is increasing internationally. While EORC cancer presents with some distinct clinical features, there is currently insufficient evidence that age of onset should alter treatment. This study examines treatment patterns for EO versus late-onset (LO) metastatic rectal cancer in Canterbury, New Zealand, to better understand appropriate treatment strategies and there effect on patient outcomes.

METHODS

A retrospective study on all patients diagnosed with stage 4 rectal adenocarcinoma in Canterbury from 2010 to 2021 was undertaken. Patients under 50 were compared to a control group aged 60-74, analysing treatment patterns, hospital stays, and survival outcomes.

RESULTS

Between 2010 and 2021, there were 949 rectal cancer diagnoses in Canterbury, of which 23 were EO and 64 were LO with stage 4 cancer. Survival analysis revealed a significant difference in median survival times between EORC (47.9 months) and LORC patients (26.5 months; P = 0.03). There was no significant difference in the surgical or oncological management between age groups (P > 0.05). Mean admissions per 100 days of life was 0.45 in LORC and 0.44 in EORC (P = 0.9119). There was no significant difference in the median proportion of time spent in hospital between EO and LO groups (2.5 vs. 2.2 days for every 100 days of life, P = 0.88).

CONCLUSION

Surgical and oncological treatments were similar for both EORC and LORC groups. The EO group exhibited better survival, with hospitalization burdens comparable for both. These findings underline the importance of maintaining an approach to metastatic RC balancing survival and quality of life.

A qualitative exploration of perioperative subjective experiences of colorectal cancer patients undergoing fast-track surgery

Colorectal cancer significantly impacts patient quality of life and burdens healthcare systems globally. Fast-track surgery (FTS) aims to alleviate some of these impacts by expediting recovery and reduce the physiological stress associated with traditional surgical approaches. Despite the clinical efficiency of FTS, there exists a gap in the literature concerning patients' subjective experiences during the perioperative period. This study seeks to fill that gap by qualitatively exploring the perioperative experiences of patients undergoing FTS for colorectal cancer, focusing on their emotional, psychological, and informational journeys. We purposively sampled 12 colorectal cancer patients. Data were collected through semi-structured interviews and analyzed using thematic analysis to uncover the emotional and psychological nuances of the patients' experiences. Findings revealed that patients often felt under-informed and overwhelmed, impacting their psychological preparedness and satisfaction with the surgery. Despite FTS' clinical benefits, patients reported mixed emotions post-surgery, including relief and ongoing anxiety about cancer recurrence. Our findings highlight the need for enhanced patient-centered care practices, suggesting that healthcare providers should integrate more effective preoperative education and support systems to better align clinical efficiency with patient satisfaction.

WNT and TGF-Beta Pathway Alterations in Early-Onset Colorectal Cancer Among Hispanic/Latino Populations

BACKGROUND/OBJECTIVES

One of the fastest-growing minority groups in the U.S. is the Hispanic/Latino population. Recent studies have shown how this population is being disproportionately affected by early-onset colorectal cancer (CRC). Compared to corresponding non-Hispanic White (NHW) patients, Hispanic/Latino patients have both higher incidence of disease and rates of mortality. Two well-established drivers of early-onset CRC in the general population are alterations in the WNT and TGF-Beta signaling pathways; however, the specific roles of these pathways in Hispanics/Latinos are poorly understood.

METHODS

Here, we assessed CRC mutations in the WNT and TGF-Beta pathways by conducting a bioinformatics analysis using cBioPortal. Cases of CRC were stratified both by age and ethnicity: (1) early-onset was defined as <50 years vs. late-onset as ≥50 years; (2) we compared early-onset in Hispanics/Latinos to early-onset in NHWs.

RESULTS

No significant differences were evident when we compared early-onset and late-onset CRC cases within the Hispanic/Latino cohort. These results are consistent with findings from large cohorts that do not specify ethnicity. However, we found significant differences when we compared early-onset CRC in Hispanic/Latino patients to early-onset CRC in NHW patients: specifically, alterations in the gene bone morphogenetic protein-7 (BMP7) were more frequent in early-onset CRC for the Hispanic/Latino patients. In addition to these findings, we observed that both NHW patients and Hispanic/Latino patients with early-onset disease had better clinical outcomes when there was evidence of WNT pathway alterations. Conversely, the absence of TGF-Beta pathway alterations was uniquely associated with improved outcomes exclusively in early-onset Hispanic/Latino patients.

CONCLUSIONS

In toto, these findings underscore how the WNT and TGF-Beta pathways may act differently in different ethnic groups with early-onset CRC. These findings may set a stage for developing new therapies tailored for reducing cancer health disparities.

Global burden and cross-country health inequalities of early-onset colorectal cancer and its risk factors from 1990 to 2021 and its projection until 2036

PURPOSE

To explore the worldwide, regional, and country-specific burden of early-onset colorectal cancer (EO-CRC) and identify its associated risk factors between 1990 and 2021, and to project its incidence and mortality rates for 2036.

METHODS

We acquired data on EO-CRC categorized by gender, socio-demographic index (SDI), and risk factors based on the Global Burden of Disease (GBD) Study 2021. Joinpoint regression analysis was utilized to explore the variation in disease burden. The autoregressive integrated moving average (ARIMA) model was performed to forecast the disease burden up to 2036.

RESULTS

Globally, the incidence rate, prevalence rate, mortality rate, and disability-adjusted life years (DALYs) rate of EO-CRC were estimated at 5.37 (95%UI: 4.91 to 5.86)/100,000, 34 (95%UI: 30.96 to 37.35)/100,000, 2.01 (95%UI: 1.84 to 2.19)/100,000, and 101.37 (95%: 92.85 to 110.18)/100,000 in 2021. The prevalence and incidence rates of EO-CRC showed an ascending trajectory, whilst the DALYs and mortality rates demonstrated a downward trajectory between 1990 to 2021. The high-middle SDI regions and East Asia exhibited the highest EO-CRC burden among the five SDI regions and 21 GBD regions respectively. A low-whole-grains diet was the chief risk factor contributing to EO-CRC. It was predicted that the age-standardized rate (ASR) of EO-CRC incidence would increase by 5.56%, while the ASR of mortality would decrease by 13.9% globally until 2036.

CONCLUSION

The current and future global burden of EO-CRC is heavy and varies significantly across different regions and countries.

The Influence of Sociodemographic Factors and Clinical Aspects on the Quality of Life of Surgically Treated Patients with Colorectal Cancer

Introduction

Due to the increasing number of cases and the levels of mortality, colorectal cancer is still a major health problem. Therefore, the growing interest in the quality of life of patients and the assessment of the quality of life of patients with colorectal cancer seems to be particularly important. The aim of the study was to investigate and determine factors that have a significant impact on the QoL of patients who were diagnosed with colorectal cancer that was surgically treated in the Surgical Department of the 4th Military Clinical Hospital in Wroclaw.

Methods

102 respondents were enrolled into the study. The QLQ-C30, QLQ-CR29 as well as an original questionnaire regarding the socioeconomic factors were used for the assessment. The information was supplemented with patients' clinical data.

Results

According to the QLQ-C30 questionnaire the average QoL of the respondents was 55%. Factors such as male gender, younger age, higher BMI, no significant weight loss, living with family, lower level of education and being professionally active have significant positive impact on QoL. In contrary, patients with more advanced and malignant cancer with tumor located in the right half of the colon had worse QoL. The particular domains of QoL influenced by these factors were also identified. Determining these factors will allow for more effective treatment, for the shortening of the hospitalization and finally for the reduction of the costs.

Conclusion

The better QoL of the patients with colorectal cancer treated surgically showed younger men, living with family and with the support from close people, professionally active, with primary level of education, and without significant weight loss, ie less than 5% of body weight in the last 6 months. Moreover, patients with cancer located in the left colon, at a lower stage, with a lower grading demonstrated a better QoL.

Young-Onset Rectal Cancer: Is It for Real?

The incidence of early-onset colorectal cancer has been rising over the last two decades. Tumors in young patients have distinct features compared to older patients. They predominantly arise in the distal colon and rectum and have poor histological features. Patients tend to present at a more advanced stage and be exposed to more aggressive management approaches; however, this has not translated into a significant survival benefit compared to their older counterparts. This chapter will share current evidence on risk factors and management options for early onset colorectal cancer with a focus on rectal cancer.

Risk factors, histopathological landscape, biomarkers, treatment patterns and survival of early-onset colorectal cancer: A narrative review

Early-onset colorectal cancer (EOCRC) incidence has increased in most Western countries over the last decade, with Australia at the forefront. Recent literature has thus focused on characterizing EOCRC from later-onset colorectal cancer (LOCRC). Earlier exposure to modifiable risk factors resulting in gut dysbiosis has been linked with EOCRC development. EOCRCs have more aggressive histopathological features with somatic mutations resulting in pro-inflammatory tumor microenvironments. There is a tendency to treat EOCRCs with multimodal chemotherapeutic regimens and more extensive surgery than LOCRCs with conflicting postoperative outcomes and survival data. Current research is limited by a lack of Australasian studies, retrospective study designs, and heterogeneous definitions of EOCRC. Future research should address these and focus on investigating the role of immunotherapies, establishing minimally invasive diagnostic biomarkers and nomograms, and evaluating the survival and functional outcomes of EOCRC.

Addressing the Rising Trend in Early-Age-Onset Cancers in Canada

A multi-disciplinary symposium on early-age onset cancer (EAOC) was held in October 2023 to explore challenges experienced by this rapidly growing population. A major outcome of the symposium was recognition of the remarkable similarities of EAOC patients' journeys across cancer sites. Prevention and early detection of cancer are hindered by a lack of awareness among patients and family doctors that cancer can and does occur in younger persons. Distinct characteristics of the disease-such as a later stage at diagnosis and more aggressive tumor biology-require more potent treatments, which result in profound physical and psychosocial consequences that are unique to this age group. EAOC patient empowerment emerged as another key theme of the symposium. The development of a greater number of specialized clinics was called for, and patient support groups were recognized for the vital role they play in empowering patients and their families. Leading-edge medical advancements hold tremendous hope across the spectrum of EAOC care. New technologies based on genomic profiling, immunotherapy and microbiome alteration contribute to the development of highly effective, personalized approaches to treatment. All symposium participants expressed their commitment to speak with one resounding voice to advocate for equitable access to leading care practices for EAOC patients; thus, a fourth symposium is planned for November 2024.

The health-related quality of life of early-onset colorectal cancer patients: an Australian cross-sectional study

AIM

Early-onset colorectal cancer (EOCRC) patients are more likely to have advanced disease and undergo more aggressive treatment modalities. However, current literature investigating the health-related quality of life (HRQoL) of EOCRC patients is scarce. This study aimed to determine the HRQoL of an Australian cohort of EOCRC patients including a subset who underwent pelvic exenteration (PE) or cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

METHOD

A cross-sectional study of EOCRC patients treated at the Royal Prince Alfred Hospital, Sydney Australia was performed. Patients were divided into groups based on the time interval from their index operation: ≤2 years and >2 years. HRQoL was evaluated using the SF-36v2 questionnaire.

RESULTS

A total of 50 patients were included. For patients ≤2 years from surgery, the median physical component summary (PCS) and mental health component summary (MCS) scores were 53.3 (36.4-58.9) and 47.3 (37.5-55.7). In the >2 years group, the median PCS and MCS scores were 50.6 (43.3-57.7) and 50.2 (39.04-56.2), respectively. Stage I (vs. stage II) disease and emergency (vs. elective) surgery conferred poorer PCS scores in patients ≤2 years from surgery. No other variables impacted PCS or MCS scores in EOCRC patients in either group.

CONCLUSIONS

HRQoL of EOCRC patients was equivocal to the Australian population. Having an earlier stage of diagnosis and emergency index operation was associated with poorer levels of physical functioning in patients ≤2 years from surgery. However, because of the limitations of this study, these findings require validation in future large-scale prospective research.

Investigation of postoperative erectile dysfunction in colorectal surgery patients and comparison of results

BACKGROUND

Although surgical treatment is curative for colorectal cancers, erectile dysfunction (ED) is one of the complications that affect the patient quality of life. The present study aimed to evaluate sexual dysfunction in patients who underwent anterior resection (AR) and low AR (LAR) surgery secondary to rectosigmoid pathologies in our clinic, to analyze the effective variables, and to compare the results.

METHODS

In the retrospectively designed study, male patients who underwent surgery for malignancy or other surgical pathologies in the General Surgery Clinic between January 2017 and December 2022 were examined. Female gender, patients under 18 years of age, and patients who refused to participate in the study were excluded.

RESULTS

The high age of the patient increased the risk of severe ED in the postoperative period. However, surgical technique, alcohol use, American Society of Anesthesiologists (ASA) score, and Clavien-Dindo class were not determinants in the presence of severe ED.

CONCLUSION

ED is an emerging medical problem that affects patients who undergo colorectal surgery adversely both in social and psychological aspects. Discussions on the issue are still ongoing. Clinicians' concerns can be addressed in the future as the number of prospectively designed studies involving more homogeneous and larger populations increases.

Do treatment patterns differ in those with early-onset colorectal cancer?

BACKGROUND

The incidence of early-onset colorectal cancer (EOCRC) is increasing. International guidelines state that treatment should not differ from that of older patients. Several studies have shown that patients under 50 years are receiving more aggressive treatment, without any survival benefit. We aim to determine if treatment for stages 2 and 3 EOCRC differs from those of late-onset colorectal cancer (LOCRC) patients.

METHODS

This was a retrospective, population-based, cohort study of the treatment patterns of patients diagnosed with colorectal cancer in Canterbury, New Zealand, from 2010 to 2021 age <50 years, compared to those aged 60-74 years.

RESULTS

A total of 3263 patients were diagnosed with CRC between 2010 and 2021. Following exclusions, we identified 130 EOCRC and 668 LOCRC patients. Stage 2 EOCRC patients are more likely to be offered adjuvant chemotherapy (p = <0.001). Furthermore, EOCRC patients with either stage 2 or 3 disease are more likely to receive multi-agent therapy (p =  <0.01), without any associated increase in survival.

CONCLUSION

EOCRC patients are given more adjuvant chemotherapy, without a corresponding improvement in outcomes, highlighting a potential for increased treatment-related harms, particularly in stage 2 disease. Clinicians should be mindful of these biases when treating young cancer patients and need to carefully consider treatment-related harms.

Functional quality of life among newly diagnosed young adult colorectal cancer survivors compared to older adults: results from the ColoCare Study

PURPOSE

Colorectal cancer (CRC) incidence and mortality are increasing among young adults (YAs) aged 18-39. This study compared quality of life (QOL) between YA and older adult CRC survivors in the ColoCare Study.

METHODS

Participants were grouped by age (years) as follows: 18-39 (YA), 40-49, 50-64, and 65 + . Functional QOL (physical, social, role, emotional, cognitive) and global QOL were assessed with the EORTC-QLQ-C30 at enrollment, 3, 6, and 12 months. Average scores were compared between groups over time using longitudinal mixed-effect modeling. Proportions with clinically meaningful QOL impairment were calculated using age-relevant thresholds and compared between groups over time using logistic regression with mixed effects.

RESULTS

Participants (N = 1590) were n = 81 YAs, n = 196 aged 40-49, n = 627 aged 50-64, and n = 686 aged 65 + . Average physical function was better among YAs than participants aged 50-64 (p = 0.010) and 65 + (p < 0.001), and average social function was worse among YAs than aged 65 + (p = 0.046). Relative to YAs, all age groups were less likely to report clinically meaningful social dysfunction (aged 40-49 OR = 0.13, 95%CI = 0.06-0.29; aged 50-64 OR = 0.10, 95%CI = 0.05-0.21; aged 65 + OR = 0.07, 95%CI = 0.04-0.15) and role dysfunction (aged 40-49 OR = 0.36, 95%CI = 0.18-0.75; aged 50-64 OR = 0.41, 95%CI = 0.22-0.78; aged 65 + OR = 0.32, 95%CI = 0.17-0.61). Participants aged 40-49 were also less likely to report physical dysfunction (OR = 0.42, 95%CI = 0.19-0.93).

CONCLUSION

YA CRC survivors reported better physical and worse social function compared to older CRC survivors, and YA CRC survivors were more likely to report clinically meaningful social, role, and physical disfunction. Future work should further investigate QOL using age-relevant benchmarks to inform best practices for CRC survivorship care.

TRIAL REGISTRATION

NCT02328677, registered December 2014.

The incidence of early onset colorectal cancer in Aotearoa New Zealand: 2000-2020

BACKGROUND

The incidence of early-onset colorectal cancer (EOCRC), diagnosed before age 50, has been rising in many countries in the past few decades. This study aims to evaluate this trend in Aotearoa New Zealand and assess its impact on Māori.

METHODS

Crude incidence and age-standardized incidence of colorectal cancer (CRC) was analyzed from all new cases from the Aotearoa New Zealand national cancer registry for the period 2000-2020. Trends were estimated by sex, ethnicity, age group and location of cancer and projections made to 2040.

RESULTS

Between 2000 and 2020, there were a total of 56,761 cases of CRC diagnosed in Aotearoa New Zealand, 3,702 of these being EOCRC, with age-standardized incidence decreasing significantly (P = 8.2 × 10- 80) from 61.0 to 47.3 cases per 100,000. EOCRC incidence increased on average by 26% per decade (incidence rate ratio (IRR) 1.26, p = < 0.0001) at all sites (proximal colon, distal colon and rectum), while the incidence in those aged 50-79 years decreased on average by 18% per decade (IRR 0.82, p = < 0.0005), again across all sites. There was no significant average change in CRC incidence in those over 80 years. In Māori, there was no significant change in age-standardized incidence. There was however a significant increase in crude incidence rates (IRR 1.28, p = < 0.0005) driven by significant increases in EOCRC (IRR1.36, p = < 0.0005). By 2040, we predict the incidence of EOCRC will have risen from 8.00 to 14.9 per 100,000 (6.33 to 10.00 per 100,000 in Māori). However, due to the aging population an estimated 43.0% of all CRC cases will be diagnosed in those over 80 years of age (45.9% over 70 years of age in Māori).

CONCLUSION

The age-standardized incidence of CRC from 2000 to 2020 decreased in Aotearoa New Zealand, but not for Māori. The incidence of EOCRC over the same period continues to rise, and at a faster rate in Māori. However, with the ageing of the population in Aotearoa New Zealand, and for Māori, CRC in the elderly will continue to dominate case numbers.

Incidence versus treatment outcomes and survival in patients before age 40 with colorectal cancer

<b><br>Introduction:</b> Colorectal cancer (CRC) was the third most common cancer and the second cause of cancer deaths worldwide in 2020. Its incidence has increased dramatically in people under 50 years of age (early-onset colorectal cancer; EOCRC).</br> <b><br>Aim:</b> The aim of this study was to compare two age groups of patients with colorectal cancer in terms of stage, prognostic factors, survival and incidence of recurrence.</br> <b><br>Materials and methods:</b> The study group consisted of 588 patients operated on between 1995 and 2005 at the University Hospital in Krakow in the Clinical Department of General, Oncological and Gastroenterological Surgery. A method of retrospective documentation analysis was used. Patients were divided into two age groups: up to forty years of age and between 45 and 65 years of age.</br> <b><br>Results:</b> Up to 40 years of age, stage IV colorectal cancer was diagnosed in 33.3% of patients, while between 45 and 65 years of age, it was diagnosed in 26.1%. Five-year survival differed according to tumour stage. In the two groups analysed, there was a significant difference between the survival curves (P = 0.00000). Also, comparing recurrence times in the paired group excluding cancer-independent deaths revealed a statistically significant difference between the groups (P = 0.006).</br> <b><br>Discussion:</b> The incidence of colorectal cancer has increased worldwide in young people under 50 years of age, and it is therefore recommended that the research presented here be studied, and that prognostic factors be analysed and multicentre prophylactic studies combined with health education of those at risk be encouraged. Cancer occurring in younger patients is characterized by advanced stage at diagnosis and five-year survival is lower and has a poorer prognosis. The availability is very important of early diagnosis to detect pre-cancerous and considered pre-cancerous conditions is important. This involves detecting lesions at a lower stage of the disease.</br> <b><br>Conclusions:</b> The availability of early diagnosis to detect precancerous and considered pre-cancerous conditions is very important. This involves detecting lesions at a lower stage of the disease. Diagnosing colorectal cancer at an early stage and treating the pre-cancerous lesions will improve treatment outcomes, resulting in fewer metastases and longer survival and recurrence times.</br>.

Factors Associated With Quality of Life Among Colorectal Cancer Patients: Cross-Sectional Study

INTRODUCTION

Colorectal cancer is a chronic condition that affects a substantial proportion of the global population. Ensuring a satisfactory quality of life (QoL) for these patients is, therefore, of critical importance.

OBJECTIVE

To examine the relationship between sociodemographic, economic, lifestyle, and health-related variables and quality of life in patients with colorectal cancer receiving treatment at a leading health institution in Medellín, Colombia.

METHODS

This cross-sectional study included all patients aged 18 years and older who were diagnosed with colorectal cancer and treated at the VIDA Clinic Foundation in 2022. Descriptive and bivariate analyses were conducted to characterize the population and explore factors associated with QoL, as assessed using the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale. The Mann-Whitney U and Kruskal-Wallis tests were applied to compare median values across variables. A Generalized Linear Model (GLM) with a Gamma family distribution and identity link function was used to identify explanatory variables influencing QoL. Regression coefficients and 95% confidence intervals were calculated.

RESULTS

A total of 126 patients with colorectal cancer were evaluated, of whom 60.3% were women, with a median age of 61.5 years. The regression model identified poor sleep quality, lack of financial support, dissatisfaction with income, and unemployment as significant factors negatively associated with QoL, after adjusting for sociodemographic variables.

CONCLUSION

This study provides an initial exploration of health-related QoL in a Colombian population diagnosed with colorectal cancer. The findings highlight the critical influence of both health-related and socioeconomic factors on patients' QoL. A holistic approach to addressing these dimensions could enhance patient care and inform more effective support strategies.