Colorectal Cancer Symptoms Research Articles

The therapeutic effect of potentially probiotic Lactobacillus paracasei on dimethylhydrazine induced colorectal cancer in rats

This study aimed to evaluate the anti-carcinogenic and potential therapeutic effects of probiotic L. paracasei during colon carcinogenesis at the in-vivo model. 60 eight-week-old male Wistar rats were divided into five groups. The effects of L. paracasei B-14 (5 × 1010 CFU/kg/day for 7 consecutive weeks) on colorectal cancer (CRC) induced rats were studied in male Wistar rats treated with 1,2-dimethylhydrazine (30 mg/kg) for 12 weeks. The tumor incidence, number, size, and histopathological investigations, apoptosis occurrence, and cell proliferation were assessed in all groups (treated and control groups) after the end of treatment. Treatment of cancerous rats with L. paracasei decreased the symptoms of CRC like diarrhea, rectal bleeding, hair loss, and wasting. A combination of L. paracasei and 5-FU caused a significant decrease in tumor size and number and increase in total apoptotic cells (51.4%) compared to untreated control (2.1%) and DMH (5.9%) groups. Treatment with L. paracasei showed fewer dysplastic changes in the crypts, low grades of dysplasia and less proliferative and metastatic activity into deeper layers in comparison with DMH-only treated group. The lowest AgNOR counts were observed in combined L. paracasei and 5-FU treated group. Anti-apoptotic and apoptosis-inducing genes were downregulated and upregulated respectively in L. paracasei treated rats. The results of the present study suggest that L. paracasei possesses therapeutic potential for decreasing the progression of colorectal cancer and enhance the anti-tumor effects of 5-FU.

Recognising Colorectal Cancer in Primary Care.

Colorectal cancer (CRC) is the third most common cancer worldwide. Primary care professionals can play an important role in both prevention and early detection of CRC. Most CRCs are attributed to modifiable lifestyle factors, which can be addressed within primary care, and promotion of population-based screening programmes can aid early cancer detection in asymptomatic patients. Primary care professionals have a vital role in clinically assessing patients presenting with symptoms that may indicate cancer, as most patients with CRC first present with symptoms. These assessments are often challenging—many of the symptoms of CRC are non-specific and commonly occur in patients presenting with non-malignant disease. The range of options for investigating symptomatic patients in primary care is rapidly growing. Simple tests, such as faecal immunochemical testing (FIT), are now being used to guide decisions around referral for more invasive tests, such as colonoscopy, while direct access to specialist investigations is also becoming more common. Clinical decision support tools (CDSTs) which calculate cancer risk based on symptomatology, patient characteristics and test results can provide an additional resource to guide decisions on further investigation. This article explores the challenges of CRC prevention and detection from the primary care perspective, discusses current evidence-based approaches for CRC detection used in primary care (with examples from UK guidelines), and highlights emerging research which may likely alter practice in the future.

Public & private accounts of help-seeking: The implications of research methods on the presentation of narratives

ABSTRACT For people with symptoms that could indicate cancer, prompt presentation to a health care practitioner facilitates early diagnosis, improves survival, and is encouraged by public health agencies and cancer charities. Nevertheless, time to presentation from symptom onset (the patient interval) is known to vary widely. We report findings from a mixed-methods study examining help-seeking among people with symptoms of lung or colorectal cancer. Patients referred for urgent investigation were invited to complete a questionnaire about their symptoms and help-seeking experiences; 26 of these participants then took part in a semi-structured interview. Discrepant accounts of help-seeking were reported through the different research methods, with longer ‘patient intervals’ reported in interviews. We use the concept of ‘public and private accounts’ to reflect upon why socially conforming accounts of early presentation were presented in the questionnaires, whilst accounts of longer ‘patient intervals’ tended to be presented within an interview encounter.

Faecal immunochemical testing in symptomatic patients to prioritize investigation: diagnostic accuracy from NICE FIT Study

This study investigated whether a quantitative faecal immunochemical test (FIT) could be used to select patients with either high- or low-risk symptoms of colorectal cancer for urgent investigation. A double-blinded diagnostic accuracy study was conducted in 50 hospitals in England between October 2017 and December 2019. Patients were eligible for inclusion if they had been referred to secondary care with suspected colorectal cancer symptoms meeting national criteria for urgent referral and triaged to investigation with colonoscopy. The study included 9822 patients, of whom 7194 (73.2 per cent) had high-risk symptoms, 1994 (20.3 per cent) low-risk symptoms, and 634 (6.5 per cent) had other symptoms warranting urgent referral. In patients with high-risk symptoms, the sensitivity of FIT for colorectal cancer at cut-off values of 2 and 10 μg haemoglobin per g faeces was 97.7 (95 per cent c.i. 95.0 to 99.1) and 92.2 (88.2 to 95.2) per cent respectively, compared with 94.3 (84.3 to 98.8) and 86.8 (74.7 to 94.5) per cent in patients with low-risk symptoms at the same cut-off points. At cut-off values of 2, 10, and 150 μg/g, the positive predictive value for colorectal cancer was 8.9, 16.2, and 30.5 per cent respectively for those with high-risk symptoms, and 8.4, 16.9, and 35.5 per cent for those with low-risk symptoms. FIT safely selects patients with high or low risk symptoms of colorectal cancer for investigation.

Sini Decoction Ameliorates Colorectal Cancer and Modulates the Composition of Gut Microbiota in Mice.

Sini Decoction (SND), as a classic prescription of Traditional Chinese Medicine (TCM), has been proved to be clinically useful in cardiomyopathy and inflammatory bowel diseases. However, the role and mechanism of SND in colitis-associated cancer remains unclear. This study aims to evaluate the effect of SND on colorectal cancer(CRC) symptoms and further explore the changes of gut microbes mediated by SND extract in azoxymethane (AOM)/dextran sulfate sodium (DSS)-induced CRC mice through 16 S rRNA sequencing. Our results indicated that treatment with SND extract could ameliorate the tumors' malignant degree by decreasing tumor number and size. Also, the expression levels of Cyclooxygenase 2 and Mucin-2, which are typical CRC biomarkers, were reduced compared to the CRC group. In the meantime, SND extract can upregulate CD8+ T lymphocytes' expression and Occludin in the colonic mucosal layer. Besides, SND inhibited the expression of CD4+ T cells and inflammatory cytokines in CRC tissue. According to bioinformatics analysis, SND extract was also suggested could modulate the gut microbial community. After the SND treatment, compared with the CRC mice model, the number of pathogenic bacteria showed a significant reduction, including Bacteroides fragilis and Sulphate-reducing bacteria; and SND increased the relative contents of the beneficial bacteria, including Lactobacillus, Bacillus coagulans, Akkermansia muciniphila, and Bifidobacterium. In summary, SND can effectively intervene in colorectal cancer development by regulating intestinal immunity, protecting the colonic mucosal barrier, and SND can change the intestinal microbiota composition in mice.

Feasibility, engagement, and acceptability of a behavioral pain management intervention for colorectal cancer survivors with pain and psychological distress: data from a pilot randomized controlled trial.

Colorectal cancer survivors report pain and psychological distress to be burdensome long-term cancer consequences. Quality cancer survivorship care includes interventions for managing these symptoms. Yet, no studies have tested the efficacy of an accessible behavioral intervention for colorectal cancer survivors with pain and comorbid psychological distress. This paper reports on the feasibility (i.e., accrual, attrition, and adherence to study procedures), engagement, acceptability, and descriptive outcomes of a telephone-based coping skills training (CST) intervention. This randomized pilot trial assigned colorectal cancer patients (N=31) to 5 sessions of CST or standard care. CST sessions focused on cognitive-behavioral theory-based coping skills tailored to colorectal cancer symptoms of pain and psychological distress. Participants completed assessments of pain severity, self-efficacy for pain management, health-related quality of life, and psychological distress at baseline, post-treatment, and 3-month follow-up. Data indicated strong feasibility, evidenced by high completion rates for intervention sessions and assessments (93% completed all sessions; M=48.7 days; baseline=100%; post-treatment=97%; 3-month follow-up=94%). Participants demonstrated robust engagement with CST (M days per week with reported skills use=3.8) and reported high protocol satisfaction (M=3.6/4.0). Descriptive statistics showed self-efficacy for pain management and health-related quality of life improved for all participants. Findings suggest that a telephone-based CST intervention has strong feasibility, evidenced by accrual, low attrition, and adherence to intervention sessions and assessments. Likewise, participant engagement and acceptability with CST were high. These data provide a foundation for larger randomized efficacy trials of the telephone-based CST intervention.

Totally laparoscopic simultaneous resection of colorectal cancer and synchronous liver metastases: a single-center case series.

The aim of the study is to analyze the feasibility, the safety and short- and medium-term survival of totally laparoscopic simultaneous resections (LSR) of colorectal cancer (CRC) and synchronous liver metastases (LM). This is a retrospective study of a single-center series. Patients ASA IV, ECOG ≥ 2, major hepatectomies (≥ 3 segments), symptomatic CRC as well as low rectal tumors were excluded from indication. The difficulty level of all liver resections was classified as low or intermediate according to the Iwate Criteria. Dindo-Clavien classification for postoperative complications evaluation was used. 15 Patients with 21 liver lesions were included. Laparoscopic liver surgery was performed first in every case. Median size of the lesions was 20mm (r 8-69). Major complications (Dindo-Clavien ≥ 3) occurred in 3 patients (20%); median hospital stay was 7days (r 4-35), and only one patient (6.6%) was readmitted upon the first month from the surgery. 90-day mortality rate was 0%. After a median follow-up of 24months (r 7-121), disease-free survival at 1, 2 and 3years was 58%, 36% and 24%, respectively; overall survival at 1, 2 and 3years was 92.3%. In selected patients, LSR of CRC and LM is technically feasible and has an acceptable morbidity rate and mid-term survival.

The multiple mediating effects of cancer threat appraisal and quality of life on the association between mindfulness and depression for colorectal cancer survivors.

This study explored the multiple mediating effects of cancer threat appraisal, functional status, and symptom distress on the association between mindfulness and depression in colorectal cancer (CRC) patients at the transition stage after completing cancer treatments. A total of 90 CRC survivors who received cancer treatments within 3months participated in this cross-sectional study. The functional status and symptom distress (EORTC-C30 and EORTC CR29), dispositional mindfulness (Five Facet Mindfulness Questionnaire), cancer threat appraisal ( Constructed Meaning Scale), and depressive symptoms (Beck Depression Inventory-II scale) were collected. The mediation and moderation analyses were conducted using the PROCESS macros for SPSS. Survivors' dispositional mindfulness (γ=-0.49, p<0.001) and cancer threat appraisal (γ=-0.59, p<0.001) were significantly associated with depressive symptoms. Simple mediation analysis indicated that cancer threat appraisal mediated the relationship between dispositional mindfulness and depression (β=-0.02, 95% CI=-0.04 to -0.001). The multiple mediated analysis identified the path between dispositional mindfulness and depression via cancer threat appraisal and colorectal symptom distress (β=-0.01, 95% CI=-0.03 to -0.01). In the mediated moderation model, the path between dispositional mindfulness and depression via colorectal function was moderated by cancer threat appraisal (β=-0.02, 95% CI=-0.05 to -0.004). The two cognitive mechanisms of reducing CRC survivors' depression are as follows: (1) dispositional mindfulness reducing the appraisal of cancer as a threat and increasing positive perceptions of CRC symptoms and (2) the cancer threat appraisal buffered the impacts of CRC's mindfulness and colorectal function on depressive symptoms. Developing mindfulness with cognitive training is recommended for improving depressive symptoms among CRC patients in the transition period.

Symptom Perceptions and Help-Seeking Behaviours of Omani Patients Diagnosed with Late-Stage Colorectal Cancer: A Qualitative Study.

Objective: Colorectal cancer (CRC) is the fourth leading cause of mortality in Oman, with most patients diagnosed at advanced stages. Early diagnosis of CRC improves prognosis and survival rate. The aim of this study was to explore the symptom perceptions and help-seeking behaviours (HSBs) of Omani patients diagnosed with late-stage CRC. Methods:Semi-structured individual interviews were conducted with 16 patients. Results:Four main themes emerged, including normalisation and ignorance (patients felt healthy, perceived symptoms as not being serious and related to dietary habits, concealed them or prioritised work and family commitments), self-empowerment and self-management (patients were stubborn, employed ‘wait and see’ approach, used symptomatic or herbal treatments), disclosure and seeking help (patients disclosed symptoms to family members or friends, sought medical help only when symptoms worsened, visited faith healers or travelled abroad for treatment) and healthcare professionals (patients attributed treatment or diagnosis delays to lack of continuity of care, loss of trust in doctors or delays in referral).Conclusion:Patients attributed delays in CRC diagnosis to several factors based on their perceptions of symptoms. Most HSBs driven by sociocultural and emotional causes. Increased awareness of CRC symptoms and modifying HSBs can encourage early diagnosis. Prompting patients to disclose CRC-related symptoms may aid referral decisions.

Diagnostic performance of a faecal immunochemical test for patients with low-risk symptoms of colorectal cancer in primary care: an evaluation in the South West of England

BackgroundThe faecal immunochemical test (FIT) was introduced to triage patients with low-risk symptoms of possible colorectal cancer in English primary care in 2017, underpinned by little primary care evidence.MethodsAll healthcare providers in the South West of England (population 4 million) participated in this evaluation. 3890 patients aged ≥50 years presenting in primary care with low-risk symptoms of colorectal cancer had a FIT from 01/06/2018 to 31/12/2018. A threshold of 10 μg Hb/g faeces defined a positive test.ResultsSix hundred and eighteen (15.9%) patients tested positive; 458 (74.1%) had an urgent referral to specialist lower gastrointestinal (GI) services within three months. Forty-three were diagnosed with colorectal cancer within 12 months. 3272 tested negative; 324 (9.9%) had an urgent referral within three months. Eight were diagnosed with colorectal cancer within 12 months. Positive predictive value was 7.0% (95% CI 5.1–9.3%). Negative predictive value was 99.8% (CI 99.5–99.9%). Sensitivity was 84.3% (CI 71.4–93.0%), specificity 85.0% (CI 83.8–86.1%). The area under the ROC curve was 0.92 (CI 0.86–0.96). A threshold of 37 μg Hb/g faeces would identify patients with an individual 3% risk of cancer.ConclusionsFIT performs exceptionally well to triage patients with low-risk symptoms of colorectal cancer in primary care; a higher threshold may be appropriate in the wake of the COVID-19 crisis.

Fear of Cancer Progression and Health Behaviors in Patients with Colorectal Cancer.

Objectives: Preparation of patients for colon tumor resection, which involves giving up smoking, reducing alcohol intake, having a proper diet, and increasing physical activity, significantly shortens the hospitalization period. In this study, we aimed at determining the relationship between the fear of cancer progression (FoP) and health behaviors among people with colon cancer. Methods: Participants were patients a week before a colon tumor surgery and 6 months after. Measured variables included smoking, alcohol intake, anti-health products intake (anti-health behaviors), physical activity, pro-health products intake (pro-health behaviors), and fear of progression cancer. Results: Comparing the week before the surgery and 6 months after revealed a decrease in smoking (η² = .02), alcohol intake (η² = .03), anti-health products intake (η² = .06) and physical activity (η² = .06). A higher level of fear of cancer progression is related to decrease in anti-health behaviors, but does not affect the change in health-promoting behaviors among patients with colorectal cancer. Conclusions: FoP is an important factor facilitating the limitation of anti-health behaviors such as alcohol and anti-health products intake. Symptoms of colorectal cancer have negative influence on physical activity and intake of pro-health products.

Patient Satisfaction with Colorectal Rapid Access Clinic

Aims: Patients referred with red flag colorectal cancer symptoms are seen within 2 weeks of referral and require completion of treatment within 62 days of referral. The demand on resources is such that the remit of this rapid access pathway (RAP) is to diagnose or exclude cancer quickly. It is hypothesised that patients on these pathways are less likely to have their symptoms addressed and more likely to be dissatisfied with the service received.&#x0D; Study Design: Questionnaire based study of all patients attending new colorectal outpatient appointments, both routine and RAP.&#x0D; Place and Duration of Study: All patients referred the colorectal department at West Suffolk Hospital, a district general hospital, during January 2018 were sent a questionnaire 6 months later.&#x0D; Methodology: Results were analysed for statistically significant differences between the two groups in relation to patient satisfaction.&#x0D; Results: Of 273 new patients, questionnaires were returned by 78 patients attending rapid access clinics and 61 attending routine new appointments. There was no significant difference in the overall level of satisfaction with the overall investigation and management process between patients seen in rapid access clinics or routine new appointments (P = 0.867). Patients on the RAP were less likely to have been given a diagnosis (p = 0.001) or advice on managing their symptoms (P = 0.002). When assessing a number of variables, only patients whose symptoms had resolved were significantly more satisfied with the overall care pathway (P = 0.037).&#x0D; Conclusion: Patients seen on the RAP are not less satisfied with their care.

Factors contributing to time to diagnosis in symptomatic colorectal cancer: A scoping review.

Colorectal cancer (CRC) is the third most common cancer worldwide (Ferlay et al., 2015, International Journal of Cancer, 136, E359), and delayed diagnosis is associated with mortality (Tørring et al., 2011, British Journal of Cancer, 104, 934; Tørring et al., 2012, Journal of Clinical Epidemiology, 65, 669). The purpose of this review was to determine the factors associated with time to diagnosis in symptomatic CRC using scoping review methods. We performed database and citation searches to identify studies which examine the length of any interval from symptom presentation to diagnosis. Study selection was conducted by two independent reviewers. Factors contributing to time to diagnosis were extracted from selected articles and mapped onto a conceptual framework consisting of four levels: patient and disease factors, provider factors, organisation/setting factors and sectors of influence. From the 31 studies included in this review, we identified 138 unique factors, 17 of which were investigated by at least three studies and 11 of which had consistent results. Patient and disease factors were most commonly studied. Patient perception that their symptoms were benign, a non-urgent referral, female sex and rectal tumour location were each associated with a longer time to diagnosis. Thus far, the literature has focused on patient or disease-related factors, while other levels of influence have been relatively understudied.

Impact of colorectal cancer screening participation in remote northern Canada: A retrospective cohort study.

BACKGROUNDScreening provides earlier colorectal cancer (CRC) detection and improves outcomes. It remains poorly understood if these benefits are realized with screening guidelines in remote northern populations of Canada where CRC rates are nearly twice the national average and access to colonoscopy is limited.AIMTo evaluate the participation and impact of CRC screening guidelines in a remote northern population.METHODSThis retrospective cohort study included residents of the Northwest Territories, a northern region of Canada, age 50-74 who underwent CRC screening by a fecal immunohistochemical test (FIT) between January 1, 2014 to March 30, 2019. To assess impact, individuals with a screen-detected CRC were compared to clinically-detected CRC cases for stage and location of CRC between 2014-2016. To assess participation, we conducted subgroup analyses of FIT positive individuals exploring the relationships between signs and symptoms of CRC at the time of screening, wait-times for colonoscopy, and screening outcomes. Two sample Welch t-test was used for normally distributed continuous variables, Mann-Whitney-Wilcoxon Tests for data without normal distribution, and Chi-square goodness of fit test for categorical variables. A P value of < 0.05 was considered to be statistically significant.RESULTS6817 fecal tests were completed, meaning an annual average screening rate of 25.04%, 843 (12.37%) were positive, 629 individuals underwent a follow-up colonoscopy, of which, 24.48% had advanced neoplasia (AN), 5.41% had CRC. There were no significant differences in stage, pathology, or location between screen-detected cancers and clinically-detected cancers. In assessing participation and screening outcomes, we observed 49.51% of individuals referred for colonoscopy after FIT were ineligible for CRC screening, most often due to signs and symptoms of CRC. Individuals were more likely to have AN if they had signs and symptoms of cancer at the time of screening, waited over 180 d for colonoscopy, or were indigenous [respectively, estimated RR 1.18 95%CI of RR (0.89-1.59)]; RR 1.523 (CI: 1.035, 2.240); RR 1.722 (CI: 1.165, 2.547)].CONCLUSIONScreening did not facilitate early cancer detection but facilitated higher than anticipated AN detection. Signs and symptoms of CRC at screening, and long colonoscopy wait-times appear contributory.

The number of obstructive colorectal cancers in Japan has increased during the COVID-19 pandemic: A retrospective single-center cohort study

BackgroundThe global pandemic of COVID-19 has changed cancer treatment environments. In Japan, cancer screenings were halted and the numbers of endoscopies and surgeries were restricted in some hospitals based on the state of emergency declared. Herein, we investigated the impact of the COVID-19 pandemic on the characteristics of colorectal cancer (CRC) patients in facilities that are on the frontline of both COVID-19 and cancer treatments. Patients and methodsWe retrospectively analyzed the cases of all of the CRC patients (n = 123) who underwent surgery at our regional cancer treatment center and tertiary emergency hospital in Japan during a 120-day period ranging from before to after the state of emergency declaration. CRC patients during the corresponding period in the previous year were also examined. ResultsAlthough the number of CRC patients did not show a significant change related to the pandemic, the incidence of obstructive CRCs significantly increased after the pandemic's start. The numbers of outpatients and colonoscopies both decreased, which could have resulted in the decrease of CRC patients detected by cancer screening during the pandemic. The numbers of symptomatic CRC patients and emergency admissions both increased significantly during the pandemic. ConclusionOur findings indicate the possibility that the discovery of CRCs in patients could be delayed due to the halt in screenings caused by the COVID-19 pandemic, resulting in the increase of obstructive CRCs. These results highlight the importance of cancer screening and suggest that the screening system for cancers should be reorganized before future pandemics.

PolypSegNet: A modified encoder-decoder architecture for automated polyp segmentation from colonoscopy images

Colorectal cancer has become one of the major causes of death throughout the world. Early detection of Polyp, an early symptom of colorectal cancer, can increase the survival rate to 90%. Segmentation of Polyp regions from colonoscopy images can facilitate the faster diagnosis. Due to varying sizes, shapes, and textures of polyps with subtle visible differences with the background, automated segmentation of polyps still poses a major challenge towards traditional diagnostic methods. Conventional Unet architecture and some of its variants have gained much popularity for its automated segmentation though having several architectural limitations that result in sub-optimal performance. In this paper, an encoder-decoder based modified deep neural network architecture is proposed, named as PolypSegNet, to overcome several limitations of traditional architectures for very precise automated segmentation of polyp regions from colonoscopy images. For achieving more generalized representation at each scale of both the encoder and decoder module, several sequential depth dilated inception (DDI) blocks are integrated into each unit layer for aggregating features from different receptive areas utilizing depthwise dilated convolutions. Different scales of contextual information from all encoder unit layers pass through the proposed deep fusion skip module (DFSM) to generate skip interconnection with each decoder layer rather than separately connecting different levels of encoder and decoder. For more efficient reconstruction in the decoder module, multi-scale decoded feature maps generated at various levels of the decoder are jointly optimized in the proposed deep reconstruction module (DRM) instead of only considering the decoded feature map from final decoder layer. Extensive experimentations on four publicly available databases provide very satisfactory performance with mean five-fold cross-validation dice scores of 91.52% in CVC-ClinicDB database, 92.8% in CVC-ColonDB database, 88.72% in Kvasir-SEG database, and 84.79% in ETIS-Larib database. The proposed network provides very accurate segmented polyp regions that will expedite the diagnosis of polyps even in challenging conditions.

Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway: a diagnostic accuracy study

ObjectiveTo assess whether a faecal immunochemical test (FIT) could be used to select patients with suspected colorectal cancer (CRC) symptoms for urgent investigation.DesignMulticentre, double-blinded diagnostic accuracy study in 50 National...

Attitudes toward and Knowledge of Colorectal Cancer Screening among an Omani Adult Population Attending a Teaching Hospital.

Objective:Colorectal cancer (CRC) is the third most commonly diagnosed cancer in Oman after breast and thyroid. Awareness regarding the availability of CRC screening services could play a major role in promoting early detection and reducing mortality rates. The aim of this study was to identify public knowledge and attitudes toward CRC screening. Methods:This cross-sectional study was conducted among 410 members of the public attending the Sultan Qaboos University Hospital in Muscat, Oman. A questionnaire was developed to assess the participants’ general knowledge, barriers and factors affecting attitudes, beliefs and behaviors regarding CRC screening. Results:A total of 410 members of the public participated from 500 invited (response rate: 82.0%). Most of the participants had not heard of CRC screening (76.3%) and were unaware of different screening methods (92.9%). The majority (93.9%) had not undergone CRC screening in Oman; however, 70.6% reported that they would be willing to do so in the future, particularly if recommended by doctors (52.7%). Barriers to screening included feeling embarrassed by the idea of a colonoscopy (73.9%), not having any symptoms of CRC (65.1%) and a fear of being diagnosed with CRC (55.6%). A bivariate analysis indicated that males demonstrated significantly more awareness of CRC screening compared to females (64.9% versus 35.1%; p = 0.004) and younger participants (<40 years of age) were significantly more aware of CRC screening compared to their older counterparts (75.3% versus 24.7%; p = 0.025). Conclusions:The majority of public in Oman showed low knowledge and awareness of CRC screening and identified several emotional barriers that might result in poor participation should screening be considered. Public education and the involvement of healthcare professionals is paramount to the implementation of a large-scale CRC screening program in Oman. In addition, addressing the sources of emotional barriers to screening is necessary.

S0302 Symptoms of Non-Hereditary Colorectal Cancer Before Age 45: Are We Listening to Our Patients?

INTRODUCTION: Colorectal cancer is the second leading cause of cancer death in the United States. Recent studies have led the American Cancer Society to recommend colorectal cancer screening begin at age 45 rather than 50 in the average risk patient. Patients often present with symptoms associated with colorectal cancer long before their diagnosis. Reasons for delays in diagnoses appear to be multifactorial. We aimed to further characterize the timing of diagnosis of colorectal cancer and factor contributing to its delay in patients younger than age 45. METHODS: We conducted a single quaternary center retrospective study of patients diagnosed with colon or rectal cancer between October 2007 and October 2018. We stratified patients by those diagnosed under age 45 and compared them to a control group of patients diagnosed above age 50. Patients with hereditary colorectal cancer or a family history of colorectal cancer were excluded. Time between symptom presentation and diagnosis, reasons for delay of diagnosis, demographics, comorbidities and family history and were recorded. Statistical analysis with chi-square and Wilcoxon sign-ranked tests were conducted using SPSS. RESULTS: Between October 2007 and October 2018, 122 cases of colorectal cancer were diagnosed at our institution in patients under the age of 45. The median age at diagnosis was 42 compared to 65 in patients above 50. Patients under 45 had a greater delay in diagnosis after initial report of symptoms compared to patients over 50 (15.4 vs 6.1 months, P < 0.0001). The most frequent cause of delayed diagnosis in both groups was found to be hesitation in presenting to a physician. Both patients diagnosed under the age of 45 and above 50 were predominantly male (55.1% and 51.6%). Patients diagnosed under the age of 45 had a lower prevalence of smoking compared to those above 50 (32.8% vs 56.8%, P < 0.0001). CONCLUSION: Our study demonstrates an alarming difference in the latency between presentation and diagnosis of colorectal cancer in those under 45 and above 50. Significant differences between the delay in diagnosis in patients below the age of 45 and those above 50 suggest that current guidelines may not be adequate in screening for colorectal cancer. Further studies aimed at risk stratification this younger age group are necessary. Additional efforts aimed at creating awareness on the risk of colorectal cancer in this population are necessary for both patients and providers.Table 1.: Comparison in patients diagnosed with colorectal cancer above age 50 and those diagnosed below age 45

S0279 Predicted Colorectal Cancer Outcomes With Reported Adherence to Follow-Up Colonoscopy After a Positive Stool-Based Test

INTRODUCTION: Colonoscopy (COL) non-adherence following a positive non-invasive colorectal cancer (CRC) screening test (e.g., multitarget stool DNA [mt-sDNA], fecal immunochemical test [FIT]) undermines the achievable benefits of screening. Given wide variations in the limited data reporting COL adherence after a positive non-invasive test, microsimulation modeling was used to estimate the clinical implications of this understudied input. METHODS: An average-risk US population cohort free of diagnosed CRC at age 40 that underwent triennial mt-sDNA or annual FIT screening from ages 50 to 75 was simulated using the validated CRC-AIM model. Three scenarios were modeled: (S1) assumed 100% adherence for initial screening and COL follow-up; (S2) reported adherence rates for initial mt-sDNA (71%) or FIT (43%) screening, with assumed 100% adherence to COL follow-up; and (S3) reported adherence rates for initial mt-sDNA or FIT screening and reported adherence rates for COL follow-up after positive mt-sDNA (73%) or FIT (47%). Sensitivity analyses were performed using 100% and reported adherence rates for mt-sDNA and FIT screening, with COL follow-up adherence ranging from 40%-100%. Patients without a COL follow-up were assumed to be non-adherent until CRC symptom onset. Outcomes for each scenario are per 1000 individuals. RESULTS: S1, S2, and S3 each yielded life-years gained (LYG) and reductions in CRC incidence and CRC mortality with either mt-sDNA or FIT screening vs no CRC screening (Table 1). Estimated LYG for mt-sDNA and FIT were 297 and 316 for S1, 284 and 245 for S2, and 203 and 113 for S3, respectively. Reductions in CRC incidence for mt-sDNA and FIT were 64% and 68% for S1, 61% and 50% for S2, and 43% and 23% for S3, respectively; reductions in CRC mortality were 72% and 76% for S1, 69% and 59% for S2, and 49% and 27% for S3, respectively. With assumed 100% adherence to mt-sDNA or FIT screening, the LYG transition was at 45% (LYG = 128) and 40% (LYG = 119) adherence for COL follow-up, respectively (Figure 1). At reported adherence for stool-tests, the additional LYG for mt-sDNA vs FIT ranged from 12 to 188 as follow-up COL adherence increased from 40% to 100% (Figure 2). CONCLUSION: These modeling analyses demonstrate that the inclusion of more realistic estimates for mt-sDNA, FIT, and COL follow-up adherence has substantial impact on the predicted outcomes. Using reported adherence rates, rather than assuming 100% adherence, mt-sDNA yields greater CRC screening benefits vs FIT.Table 1.: Predicted life-years gained (LYG), colorectal cancer (CRC) incidence reduction, and CRC mortality reduction for triennial multitarget stool DNA (mt-sDNA) and annual fecal immunochemical test (FIT) in 3 different adherence scenarios per 1000 individuals free of diagnosed colorectal cancer at age 40 and screened between 50–75 yearsFigure 1.: Percent difference in predicted life-years gained (LYG) per 1000 individuals assuming 100% adherence for triennial multitarget stool DNA (mt-sDNA) and annual fecal immunochemical test (FIT) at assumed adherence rate intervals for follow-up colonoscopy (COL) in individuals free of diagnosed colorectal cancer at age 40 and screened between 50–75 years. White boxes indicate 10% positive difference with mt-sDNA versus FIT. Dark gray boxes indicate >10% negative difference with mt-sDNA versus FIT.Figure 2.: Percent difference in predicted life-years gained (LYG) per 1000 individuals by reported adherence rates for triennial multitarget stool DNA (mt-sDNA) and annual fecal immunochemical test (FIT) at assumed adherence rate intervals for follow-up colonoscopy (COL) in individuals free of diagnosed colorectal cancer at age 40 and screened between 50–75 years. White boxes indicate 10% positive difference with mt-sDNA versus FIT. Dark gray boxes indicate >10% negative difference with mt-sDNA versus FIT.