Colorectal Cancer In Young Adults Research Articles

Clinicopathologic Profile and Treatment Outcomes of Colorectal Cancer in Young Adults: A Multicenter Study From India.

Colorectal cancer (CRC) in young adults is a rising concern in developing countries such as India. This study investigates clinicopathologic profiles, treatment patterns, and outcomes of CRC in young adults, focusing on adolescent and young adult (AYA) CRC in a low- and middle-income country (LMIC). A retrospective registry study from January 2018 to December 2020 involved 126 young adults (age 40 years and younger) with CRC. Patient demographics, clinical features, tumor characteristics, treatment modalities, and survival outcomes were analyzed after obtaining institutional ethics committees' approval. Among 126 AYA patients, 62.70% had colon cancer and 37.30% had rectal cancer. Most patients (67%) were age 30-39 years, with no significant gender predisposition. Females had higher metastatic burden. Abdominal pain with obstruction features was common. Adenocarcinoma (65%) with signet ring differentiation (26%) suggested aggressive behavior. Limited access to molecular testing hindered mutation identification. Capecitabine-based chemotherapy was favored because of logistical constraints. Adjuvant therapy showed comparable recurrence-free survival in young adults and older patients. For localized colon cancer, the 2-year median progression-free survival was 74%, and for localized rectal cancer, it was 18 months. Palliative therapy resulted in a median overall survival of 33 months (95% CI, 18 to 47). Limited access to targeted agents affected treatment options, with only 27.5% of patients with metastatic disease receiving them. Chemotherapy was generally well tolerated, with hematologic side effect being most common. This collaborative study in an LMIC offers crucial insights into CRC in AYA patients in India. Differences in disease characteristics, treatment patterns, and limited access to targeted agents highlight the need for further research and resource allocation to improve outcomes in this population.

Colorectal Cancer in Young Adults: Considerations for Oncology Nurses.

The incidence of colorectal cancer (CRC) in the young adult population has increased during the past several decades, which is concerning to healthcare professionals. Awareness of CRC needs to be at the forefront for healthca.

Comparative genomic analysis to identify a signature of sporadic colorectal cancer development in young adults.

208 Background: Young-onset sporadic CRC is an important yet understudied heterogeneous group of aggressive cancers with distinct clinical and histopathological features. There is a steady increase in the incidence of cancer in this group of patients and currently, there are no screening guidelines to identify these patients due to a lack of understanding of the molecular mechanisms driving cancer in this patient group. Introduction: Despite screening guidelines and recent advances in cancer treatment, colorectal cancer (CRC) remains the second most diagnosed cancer and the second and third leading cause of cancer-related mortality in Canadian men and women, respectively [Canadian Cancer Statistics 2017.]. More striking is the rise in incidence of CRC in young adults in the United States [Siegel, R.L., et al, Bailey, C.E., et al., Dozois, E.J., et al., Deen, K.I., et al.], and the expectation that by the year 2030, the incidence rate will increase by 90% in this patient population. Data from the Surveillance and Cancer registry at Cancer Care Ontario shows a similar trend with increased rates in younger adults (ages 30 to 49) by 5.2 per cent per year between 2005 and 2012 [Ontario, C.C., Cancer Fact.]. Moreover, these younger patient groups are often diagnosed with aggressive forms and advanced stages of the disease [Ontario, C.C., Cancer Fact.]. Methods: In this study, using a total of 30 colorectal cancer patient samples from Windsor Regional Hospital Cancer Program, we performed comprehensive targeted gene sequencing to identify single nucleotide variants, small insertions/deletions, copy number variants in over 500 genes that are implicated in cancer. Mean age of the patients in this study was 44 years and only patients without any personal or family history of colon cancer /other malignancies or IBD were enrolled in the study. Results: While identifying previously known colorectal cancer associated genetic variants, our preliminary data shows distinct missense mutations in several genes potentially contributing to the development and progression of cancer in these patients. In addition to showing pathogenic mutations in colorectal cancers associated genes, such as PIK3CA (H1047R, E545K, E545G, R93W, V344A), KRAS (G12V, G12D, A146T) and APC, our study showed recurring missense mutations in several genes including AXIN2, ALK, CDKN1A, MAP3K1, ROS1, EPCAM, KDM5A and AURKA in over 50% of our samples. Conclusions: The genomic profiling performed using biopsies from young colorectal cancer patients through this study provides a unique ability to identify the potential “genomic triggers” for the development and progression of cancer in young sporadic colorectal cancer patients. This information can not only be used to develop targeted treatment options for these patients but also to design new screening protocols as well as optimal surveillance strategies.

Focusing on colorectal cancer in young adults (Review).

Colorectal cancer (CRC) ranks as the third leading cause of cancer-related mortality worldwide. Recent years have witnessed an increase in the incidence of CRC among adults <50 years old on a global scale. The increased incidence is associated with several modifiable risk factors, including obesity, type II diabetes, physical inactivity and frequent antibiotic use. In younger individuals, haematochezia and abdominal pain are the most common symptoms, predominantly affecting the left-side colon. While certain cases of early-onset CRC (eoCRC) are associated with a genetic predisposition, the majority result from sporadic mutations in the genes APC, KRAS, BRAF and TP53, which trigger uncontrolled cell proliferation and tumour formation. Colorectal carcinogenesis involves three major pathways: The chromosomal instability (CIN), microsatellite instability and CpG island methylator phenotype pathways. Dysregulation of the CIN pathway accounts for 85% of sporadic cases of eoCRC. Notably, eoCRC exhibits a distinctive molecular profile, characterized by a decreased prevalence of BRAF mutations, an increased prevalence of KRAS mutations and LINE-1 hypomethylation, and involvement of the Microsatellite and Chromosomal Stable pathway. Prevention strategies for eoCRC primarily centre on lifestyle modifications and the development of screening programs targeting younger populations. Further exploration into the molecular mechanisms involved in the identification of novel risk factors associated with eoCRC is imperative. These efforts, in conjunction with the development of specific screening strategies, hold the potential to reduce morbidity and mortality in the future.

S361 Increasing Incidence of Colorectal Cancer in Younger Adults: A Population-Based Time-Trend Analysis Using the Global Burden of Diseases Database, 1990-2019

S361 Increasing Incidence of Colorectal Cancer in Younger Adults: A Population-Based Time-Trend Analysis Using the Global Burden of Diseases Database, 1990-2019

Colorectal cancer in young adults.

The incidence of colorectal cancer in young adults (CRCYAs) is increasing globally, and it is now the third leading cause of cancer death among young adults under 50 years old. The rising incidence is attributed to various emerging risk factors such as genetics, lifestyle factors, and microbiome profiles. Delayed diagnosis and more advanced disease presentation contribute to worse outcomes. A multidisciplinary approach to care is crucial to ensure comprehensive and personalized treatment plans for CRCYA.

Global increase of colorectal cancer in young adults over the last 30 years: an analysis of the Global Burden of Disease Study 2019.

The US Preventive Services Task Force lowered the recommended starting age for colorectal cancer (CRC) screening in average-risk adults from 50 to 45years. We aimed to estimate the global burden and trends of colorectal cancer in adults aged 20-49years (early-onset CRC). This is an analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). The GBD 2019 estimation methods were used to describe the incidence, mortality, and disability-adjusted life years (DALYs) of early CRC from 1990 to 2019. Data from 204 countries and geographic areas were available. The global incidence rate of early-onset CRC increased from 4.2/100 000 to 6.7/100 000 from 1990 to 2019. Mortality and DALYs of early-onset CRC also increased. The CRC incidence rate increased faster in younger adults (1.6%) than in adults aged 50-74years (0.6%) as measured by the annual percentage change. The increase in early-onset CRC incidence was consistently observed in all five socio-demographic index (SDI) regions and 190 out of 204 countries and territories. Middle and high-middle SDI regions had faster annual increases in early-onset CRC, which warrants further attention. The global incidence, mortality, and DALYs of early-onset CRC increased from 1990 to 2019. The increase in early-onset CRC incidence was prevalent worldwide. Several countries were found to have higher incidence rates than the United States or fast increase in early-onset CRC, which warrants further attention.

Abstract 3049: Health-related quality of life among newly diagnosed young adult colorectal cancer patients: results from the ColoCare Study

Abstract Background: In the past decade, colorectal cancer (CRC) incidence and mortality rates have increased among young adults (YAs) 18-39 years old. Cancer can be uniquely challenging for YAs, as common cancer-related life disruptions co-occur with rapid social and emotional development and can contribute to low health-related quality of life (HRQOL), or overall well-being. The goal of this study was to examine HRQOL at several timepoints among YA CRC patients enrolled in the multi-site ColoCare Study and compare HRQOL between YA and older adult CRC patients. Methods: ColoCare is a large cohort study of newly diagnosed CRC patients. Participants complete patient-reported outcomes (PRO) surveys and provide biomarker samples prospectively from the time of diagnosis until 24 months (m). This analysis leveraged PRO data collected across six ColoCare sites at baseline (enrollment), 3m, 6m, 12m, and 24m. HRQOL was assessed with the EORTC-QLQ C30, which includes a global QOL subscale, five functional subscales (physical, role, emotional, cognitive, social), and nine symptom subscales (fatigue, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, financial difficulties). Age at diagnosis was categorized as YA (18-39 years old), average onset (AO; 40-64 years old), or late onset (LO; ≥65 years old). T-tests were used to compare HRQOL scores between age groups at each timepoint. Results: The sample included n=87 YA (5%), n=873 AO (52%), and n=712 LO (43%) CRC patients. YA CRC patients were an average of 33.75 years old (SD=4.73) and most were female (53%), White (80%), and diagnosed with stage III or IV CRC (59%). Relative to AO CRC patients, YAs reported better physical function at baseline (p=0.014) and 24m (p=0.044), less fatigue at 24m (p=0.027), and better global QOL at 24m (p=0.004). Relative to LO patients, YAs reported better global QOL at baseline (p=0.039) and 24m (p=0.001), better physical function at baseline (p&amp;lt;0.001), 3m (p=0.019), 6m (p=0.015), and 24m (p&amp;lt;0.001), less dyspnea at baseline (p=0.013), and less fatigue at 24m (p=0.007). Also relative to LO patients, YAs reported worse financial difficulties at baseline (p&amp;lt;0.001), 3m (p=0.001), 6m (p&amp;lt;0.001), and 12m (p=0.002), worse nausea/vomiting at 3m (p&amp;lt;0.001), 6m (p&amp;lt;0.001), and 12m (p=0.006), worse social function at 3m (p&amp;lt;0.018), worse emotional function at 12m (p=0.032), and worse appetite loss at 12m (p=0.029). Conclusion: Across the first two years post-CRC diagnosis, YA patients reported better HRQOL than AO and LO patients in several domains, including better physical function, less fatigue, and better global QOL. However, YAs also reported worse financial difficulties, worse social and emotional function, and worse nausea/vomiting and appetite loss relative to LO patients. These findings suggest the need for age-specific emotional, social, and symptom management support for YA CRC patients. Citation Format: Amanda Michelle Bloomer, Gillian Trujillo, Maria Gomez, Xiaoyin Li, Heather S. Jim, Jennifer Ose, Jane C. Figueiredo, Adetunji Toriola, Christopher I. Li, David Shibata, Cornelia M. Ulrich, Martin Schneider, Biljana Gigic, Laura B. Oswald, Erin M. Siegel. Health-related quality of life among newly diagnosed young adult colorectal cancer patients: results from the ColoCare Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3049.

Sexual Health Outcomes of Adolescent and Young Adult Colorectal Cancer Survivors and Their Partners: Protocol of a Dyadic Mixed Methods Study

Sexual dysfunction represents a critical aspect of quality of life for adolescent and young adult cancer survivors. Studies have consistently documented that adolescents and young adults report greater psychological and physical morbidity than older survivors and healthy peers, including elevated rates of sexual dysfunction, often accompanied by lower satisfaction with sex life and delays in meeting sexual milestones. Moreover, sexual dysfunction, body image concerns, and fertility status affect their confidence in being both physically and emotionally intimate. Despite this evidence, limited research has investigated the influence of psychosocial and interpersonal factors on sexual health outcomes reported by this group. This constitutes a significant gap in the provision of comprehensive sexual health care for adolescent- and young adult-onset cancer survivors, especially since greater emphasis has been recently placed on the biopsychosocial model of sexuality and dyadic approaches to intervention and treatment. In comparison to other cancer types, the incidence of colorectal cancer (CRC) has been increasing at an alarming rate for the adolescent and young adult group. Patients with early-onset CRC experience elevated rates of sexual dysfunction, psychological distress, and social and physical burden, often resulting from issues with bowel control, incontinence, and body image. This study uses an explanatory sequential mixed methods approach to (1) characterize sexual function, sexual distress, dyadic coping, infertility-related distress, relationship and mental health outcomes of adolescent and young adult CRC survivors within the first 5 years post diagnosis and their partners; (2) examine the reciprocal influence of sexual function and dyadic coping behaviors on sexual distress; and (3) identify interpersonal or couple characteristics associated with coping with sexual dysfunction and its associated distress. Participating couples (n=60) will complete a quantitative web-based survey investigating sexual function, sexual distress, dyadic coping, infertility-related distress, emotional functioning, relationship satisfaction, and body image (cancer survivors only). A subset of 20 couples will participate in an in-depth dyadic interview with 2 members of the research team to further explore couple-based strategies implemented to cope with cancer-related sexual dysfunction and distress. The study received institutional review board approval. Recruitment and enrollment of couples began in July 2022. Results will provide a deeper understanding of the challenges couples experience as they navigate sexual intimacy after CRC treatment by highlighting the role of interpersonal processes. These findings will inform a dyadic intervention for young couples at risk of greater sexual distress in the aftermath of CRC. DERR1-10.2196/41831.

Symptom burden over time among early-onset young adult colorectal cancer survivors.

88 Background: From 1995-2016, rates of colorectal cancer (CRC) have increased among young adults (YA) under 50 years by 2% annually, despite overall rates of CRC among adults over age 65 decreasing. Unfortunately, this population is disproportionately affected by diagnosis at later stage of disease due to systematic and healthcare factors. Such late diagnoses are associated with higher symptom burden among survivors; however, symptom burden among YA early-onset CRC (EOCRC) survivors is poorly understood. The present study aims to characterize symptom burden among YA EOCRC survivors. Methods: A cross sectional survey was administered online in collaboration with a national organization for YA CRC survivors. Respondents (18-49 years) were EOCRC survivors who were 6-36 months from diagnosis/relapse. Survivors endorsed symptoms they experienced among 23 common CRC late effects. Responses were stratified by symptom duration (6-18 versus 19-36 months) to examine differences in endorsement rates among respondents. Results: Respondents (n=235) were colon (n=86) and rectal (n=149) cancer survivors, primarily male 63%, diagnosed at 32.4 years (SD=6.65), with an average of 5.1 (SD=2.57) symptoms. Overall, the most highly reported symptoms were fatigue, perceived change in appearance after treatment, and nail color changes. Comparisons of 6-18 and 19-36 months-from-diagnosis groups revealed similar symptom endorsement rates, with those 19-36 months from diagnosis endorsing constipation/diarrhea, anal bleeding, and incisional discomfort at higher rates than those 6-18 months from diagnosis. The 6-18 and 19-36 months-from-diagnosis groups carried similar symptom burdens of 4.9 (SD=2.57) and 5.1 (SD=2.58), respectively. Conclusions: YA EOCRC survivors endorse numerous symptoms that may interfere with their daily living and quality of life. Similarities in endorsement between 6-18 month and 19-36-month groups suggest symptoms may become chronic and persist beyond cancer treatment. Fortunately, many symptoms can be mitigated or prevented with proper medical and/or psychosocial intervention, patient education, and resource availability. Providers can leverage these findings in their evaluation of YA EOCRC patients during treatment and follow-up care to ensure the delivery of optimal symptom management. [Table: see text]

Patient Care Satisfaction and Emergency Room Utilization among Young Adult Colorectal Cancer Survivors during the SARS-CoV-2 Pandemic: Lessons Learned.

Survivors of colorectal cancer (CRC) are at risk for late effects of therapy and recurrence of cancer. With recurrence rates ranging between 30-40%, follow-up care is needed for both early detection and management of late effects. Cancer care delivery for CRC patients was significantly disrupted by the SARS-CoV-2 pandemic, with decreases of 40% in such services in the United States between April 2020 and 2019. Survivors were left with fewer options for care, potentially causing increases in emergency room (ER) utilization. This cross-sectional study examined the patterns of ER utilization during the SARS-CoV-2 pandemic among young adult CRC survivors and assessed the relationship between self-reported care satisfaction and ER use. Eligible participants were colon or rectal cancer survivors diagnosed between 18-39 years of age, 6-36 months from diagnosis/relapse, English speaking and residing in the United States. Multivariable logistic regression assessed the association between patient care satisfaction and ER utilization, adjusting for pandemic factors. Covariates were chosen by significance of p &lt; 0.1 at the univariate level and perceived clinical significance. The overall sample (N = 196) had mean age (SD) 32.1 (4.5); 59% were male. Tumor location was colon or rectal in 42% and 57%, respectively, and the majority (56%) were diagnosed with stage 2 disease; 42.6% reported relapsed disease, and 20% had an ostomy. Most survivors (72.5%) had between 1-4 visits to an ER in the last 12 months and were categorized as normal utilizers. Approximately 24.7% of the sample had greater than 4 visits to the ER in the last 12 months and were categorized as super-utilizers. CRC survivors that reported a delay in their follow-up care as a result of the pandemic were two times (OR: 2.05, 95% CI 0.99, 4.24) more likely to be super-utilizers of the ER. Higher self-reported satisfaction with care was associated with a 13.7% lower likelihood of being a super-utilizer (OR: 0.86, 95%CI: -0.68, 1.09). This study found strong associations between delays in care, self-reported care satisfaction, and being a super-utilizer of the ER during the pandemic among young adult CRC survivors off treatment. Increasing patient satisfaction and minimizing care interruptions amongst this vulnerable population may aid in mitigating over-utilization in the ER during an ongoing pandemic.

Clinico-epidemiological profile and treatment outcome in adolescents and young patients of rectal cancer attending a tertiary cancer center.

The incidence of colorectal cancer in young adults is on an increasing trend. It is observed that this subgroup of patients has an aggressive disease and carries a poorer prognosis compared to its older counterpart. This study aimed to analyze the incidence, treatment outcome, and prognostic factors in adolescents and young adults with rectal cancer attending a tertiary cancer center in North India. We retrospectively analyzed 50 patients of histologically proven rectal cancer, aged up to 30 years, treated at our center between 2015 and 2019. The clinical, demographic, and pathological parameters were studied in all these patients. Kaplan-Meier survival analysis was used to find out survival. Univariate analysis was performed to assess prognostic factors. The incidence was 26.4% at our center with a median age of 28 years. Bleeding per rectum was the commonest complaint. Most of them had signet ring cell histology (26%). The median overall survival was 16 months. Survival was significantly better in patients having bleeding per rectum as an initial complaint (P = 0.009), absence of lymphovascular invasion (LVI) (P = 0.005), and perineural invasion (PNI) (P = 0.002), who received complete planned treatment compared to patients who could not receive either of the modality (P < 0.001). Patients who did not receive radiotherapy (RT) had the worst outcomes compared to those who received RT in any form. RT dose of 50.4 Gy was found to be superior as compared to other schedules. There was no significant difference in survival with gender, tumor stage, grade, type of surgery, or chemotherapy regimen. The majority of patients presented in an advanced stage. Therefore, bleeding per rectum should be properly and timely investigated in all these young patients. Early detection and complete treatment are paramount to improving the outcome.

56P Clinico-pathological profile of adolescent and young adult colorectal cancer patients: Multicentre collaborative registry data from India

The incidence of colorectal cancer (CRC) has increased among the younger population. Adolescents and young adults (AYA) are an important component of the active population in any country that impact the health care system along with socio-economic consequences. We present one of the first multicentre collaborative studies on AYA CRC from a low and middle-income country (LMIC).

S258 Global Increase of Colorectal Cancer in Young Adults Over the Last 29 Years: An Analysis of the Global Burden of Disease Study 1990-2019

S258 Global Increase of Colorectal Cancer in Young Adults Over the Last 29 Years: An Analysis of the Global Burden of Disease Study 1990-2019

Significant Rise of Colorectal Cancer Incidence in Younger Adults and Strong Determinants: 30 Years Longitudinal Differences between under and over 50s.

Simple SummaryWe aimed to assess the incidence of CRC in Crete from 1992–2021 and compare them among younger and older adults. The mean age-specific incidence rate (ASpIR/100,000/year) of colon cancer patients <50 years was 7.2 (95% CI 5.1–9.7), while for patients ≥50 years the ASpIR was 149 (95% CI 146.2–153.4). ASpIR presented a 29.6% increase from 2001 to 2011 in the age group of 20–34 years and further increase is expected from 2022–2030 (projected change, 42.8%). The main risk factors were the pack years (p = 0.01), alcohol consumption (0.02), and farmer occupation (0.04), especially during 2012–2021. We confirmed an increased incidence of CRC in young adults <50 in a European population with low cancer incidence in the past and a worrisome prediction for the near future. There is a clear indication that starting CRC screening at an earlier age may be essential.(1) Background: There is evidence in the recent literature that the incidence patterns of colorectal cancer (CRC) have changed considerably over the years, tending to rise rapidly in individuals under 50 years old compared with those over 50 years. The current study aimed to assess the incidence of CRC in Crete from 1992–2021 and compare them among younger and older adults. (2) Methods: Data on malignant neoplasms of colon, rectosigmoid junction, and rectum have been extracted from the database of the Regional Cancer Registry of Crete. (3) Results: The number of these cases for the period 1992–2021 was 3857 (n = 2895 colon and n = 962 rectum). The mean age-specific incidence rate (ASpIR/100,000/year) of colon cancer patients <50 years was 7.2 (95% CI 5.1–9.7), while for patients ≥50 years the ASpIR was 149 (95% CI 146.2–153.4). ASpIR presented a 29.6% increase from 2001 to 2011 in the age group of 20–34 years and further increase is expected from 2022–2030 (projected change, 42.8%). The main risk factors were the pack years (p = 0.01), alcohol consumption (0.02), and farmer occupation (0.04), especially during 2012–2021. (4) Conclusions: We confirmed an increased incidence of CRC in young adults <50 in a European population with low cancer incidence in the past and a worrisome prediction for the near future. The observed trends clearly indicate that starting CRC screening at an earlier age may be essential.

Beliefs Underlying Colorectal Cancer Information Seeking Among Young Black Adults: a Reasoned Action Approach Elicitation Study.

Colorectal cancer in younger adults is more likely to be diagnosed at an advanced stage. Furthermore, younger Black adults are more likely to be diagnosed with and die from colorectal cancer than younger White adults. Given these persistent racial disparities, urgent attention is needed to increase colorectal cancer awareness and information seeking among young Black adults. Guided by the reasoned action approach, the purpose of this study was to identify behavioral, normative, and control beliefs that influence general colorectal cancer information seeking, talking to a healthcare provider about colorectal cancer, and talking to family about cancer history. The sample included N = 194 participants; Mage = 28.00 (SD = 5.48). Thirty-one percent had ever searched for colorectal cancer information. We identified salient educational advantages to seeking information about colorectal cancer and talking to healthcare providers and family members about cancer history. Barriers included fear, misinformation, low priority, inaccessibility of information, and lack of interest or willingness. This is one of the few studies to investigate cancer communication behaviors among young Black adults. The findings can inform interventions to motivate engagement in cancer communication behaviors.

404P A quantitative synthesis of disparities in the inclusion of younger adults and racial/ethnic minorities in colorectal cancer clinical trials

Colorectal cancer (CRC) incidence in younger adults has been rising for unclear reasons, and clinical outcomes also differ across racial/ethnic subpopulations. We analyzed all trials for age disparity and trials recruiting from the US for racial/ethnic disparity from primary reports of CRC randomized controlled trials (1990-2021). We calculated enrollment-incidence ratios (EIR), which compare trial enrollment from an age or racial/ethnic subgroup against global estimates of incidence in the corresponding age subgroup (from Global Burden of Disease) or US-population-based incidence in the corresponding racial/ethnic subgroup (from SEER 21). Individual-trial EIRs were pooled using random-effects meta-analyses. Meta-regression was used to explore associations between key trial characteristics and EIR, as well as trends in EIR over the last three decades. Of 411 global trials, 139 trials (33.8%) reported the number of patients within pre-defined age subgroups/categories; among these, patients were most frequently reported as above/below 65 years of age (n = 86; 20.9%). Only 12 trials (2.9%) reported the number of participants younger than 50 years, while even fewer reported the number of participants younger than 45 or 40 years (n = 8; 1.9%). 78 trials (19.0%) reported a subgroup analysis by age. Of 37 US trials, 19 trials (51.4%) reported race and 5 (13.5%) reported ethnicity, with only 2 (5.4 %) reporting data on all 5 U.S. racial categories. Patients aged >65 years were significantly underrepresented (EIR: 0.85 [95% CI: 0.78 - 0.94]). Asians were under-enrolled (EIR: 0.44 [95% CI: 0.36 - 0.52]), as well as Black (EIR: 0.57 [95% CI: 0.49 - 0.66]) and Hispanic patients (EIR: 0.51 [95% CI: 0.39 - 0.67]) with the inclusion of larger, international trials. There were no significant changes in the degree of disparity over the last three decades. Despite rising incidence of CRC in younger adults, clinical trials show infrequent reporting of this age group. Racial ethnic/minorities are significantly underrepresented in colorectal clinical trials based on their share of colorectal cancer incidence.

P-242 Colorectal cancer in young adults: Experience of the medical oncology department of Fez

The recent rise of young individuals under age 50 with colorectal cancer (CRC) is a startling trend in need of greater focus and research. The rapid increase in incidence rates among young people could result from generational differences in diet, environmental exposures and lifestyle factors. The aim of this study is to describe the epidemiological changes as well as the differences in the clinicopathologic, molecular characteristics of young patients. This is a retrospective study of young patient with colorectal cancer aged < 45 and treated at the medical oncology department of Fez over a period from December 2009 to September 2020. The Kaplan Meier method was used to estimate the median survival. - 158 (24% ) patients were young, of whom 16% had family history, and 11% were obese. Mucinous adenocarcinoma was present in 53%. 46% were at the metastatic stage, of which 80% had a poorly differentiated character. At stage II, MSI status was present in 62%. The mutated RAS status was 40%.51% received trichemotherapy versus 49% bichemotherapy. The preferential site was in 52% the liver, 30% the lung and the bone in 16%. However, young patients diagnosed with early-stage tumors had a significantly better prognosis compared to early-stage tumors in the older age group. The majority of young patients with colorectal cancer often receive more aggressive treatment regimens than their older counterparts. Median overall survival in young patients was 16 months. Early-onset colorectal carcinoma are a distinct clinical group characterized by poor cellular differentiation and aggressive evolution. Several factors may well explain this apparent epidemic among young people, namely and emerging lifestyle issues such as obesity, lack of exercise and dietary factors.

Prevalence of information needs among emerging and young adult colorectal cancer survivors.

71 Background: The information needs of young adult (YA) cancer survivors have been described, however, the specific needs of YA colorectal cancer (CRC) survivors are not well-documented. Characterizing the distinct unmet needs of YA CRC survivors is important given their unique cancer experience which may include an ostomy, chronic bowel symptoms, and functional deficits. The purpose of this study was to examine CRC survivors’ unmet needs across general, clinical, and psychosocial domains. Methods: An online, cross-sectional survey was administered via Facebook in collaboration with a national YA CRC patient advocacy organization. Respondents (diagnosed 18-39) endorsed areas in which they required more information on aspects of their lives that may have been affected by their cancer experience. Needs were stratified by life stage (emerging [18-29 years] and young [30-39] adulthood). Results: Respondents (n=189) were colon (40.2%) and rectal (59.8%) cancer survivors with a mean current age of 32.2 years (SD=4.6) and a mean age of 30.2 years (SD=4.3) at diagnosis. Most endorsed items per domain included: nutrition and diet (52.1%), complementary and alternative treatments (45.4%), and talking about your cancer experience with family, friends, and co-workers (36.1%). Survivors in emerging adulthood (n=80), compared with those in young adulthood (n=109), endorsed notably greater needs in: staying physically fit (57.5% versus 38.5%), complementary and alternative treatments (57.5% versus 36.7%), and advice/help about dating and intimate relationships (18.8% versus 6.4%). Conclusions: Overall, half of respondents endorsed a desire for information on nutrition and diet, staying physically fit, and complementary and alternative treatments. Differing endorsement rates by age group indicate the importance of tailored approaches. Optimal counseling, resources, and referrals specific to life stage can mitigate the unmet needs of YA CRC survivors to improve health outcomes and quality of life.[Table: see text]

Patient care satisfaction and emergency room utilization among young adult colorectal cancer survivors during the SARS-CoV-2 pandemic.

34 Background: Survivors of colorectal cancer (CRC) are at risk for late effects of therapy and recurrence of cancer. With recurrence rates ranging between 30-40% (Siegal et al., 2020), consistent, survivor-focused follow-up care is needed for early detection of late effects and recurrence (Jeffery et al., 2019). CRC-related care delivery has been significantly disrupted by the SARS-CoV-2 pandemic, with decreases of 40% in CRC services in the United States between April 2020 and 2019 (Jammu, 2020). Consequentially, survivors may be left with fewer options for care, potentially causing increases in emergency room (ER) utilization. Methods: This cross-sectional study examined the patterns of ER utilization during the SARS-CoV-2 pandemic among young adult CRC survivors and assessed the relationship between self-reported care satisfaction and ER use. Eligible participants were diagnosed with colon or rectal cancer between 18-39 years, between 6-36 months from diagnosis/relapse, English speaking, and based in the United States. Questions on care satisfaction were Consumer Assessment of Healthcare Providers and Systems (CAHPS) questions. A multivariable logistic regression was conducted to assess the association between patient satisfaction and ER utilization, adjusting for factors related to the pandemic. Covariates for this analysis were chosen based on a significance of p &lt; 0.1 at the univariate level, as well as general clinical significance. Results: The overall sample was N = 196, mean age (SD) was 32.1 years (4.5), and 116 survivors (59%) were male. Tumor location was colon or rectal in 42% and 57%, respectively, and the majority (56%) were diagnosed with stage 2 disease; 42.6% reported relapsed disease, and 20% had an ostomy. The majority of survivors (72.5%) had between 1-4 visits to an emergency room in the last 12 months and were categorized as normal users. Approximately 24.7% of the sample had greater than 4 visits to the ER in the last 12 months and were categorized as super-utilizers (Johnson et al., 2015). Colorectal cancer survivors that reported a delay in their follow-up cancer care as a result of the pandemic were two times (OR: 2.05, 95% CI 0.99, 4.24) more likely to be super-utilizers of the ER. Higher self-reported satisfaction with overall care was associated with a 13.7% (OR: 0.86, 95%CI: -0.68, 1.09) lower likelihood of being a super-utilizer. Conclusions: This study found strong associations between delays in care, self-reported care satisfaction, and being a super-utilizer of the ER during the pandemic among young adult CRC survivors off treatment. Increasing patient satisfaction and minimizing care interruptions amongst this vulnerable population may aid in mitigating over-utilization in the ER during an ongoing pandemic.