Clinical Delays and Comparative Outcomes in Younger and Older Adults with Colorectal Cancer: A Systematic Review

BACKGROUND Colorectal cancer (CRC) is estimated to be the fourth major cancer diagnosis in Canada (except for non-melanoma skin cancers) and the second and third leading cause of cancer-related death in males and females, respectively. OBJECTIVE The rising incidence of early age-onset colorectal cancer (EAO-CRC; diagnosis at <50 years), calls for better understanding of patients’ pathway to diagnosis. We evaluated patterns of prescription medication use before EAO-CRC diagnosis. METHODS We used linked administrative health databases in British Columbia, Canada to identify cases diagnosed with EAO-CRC between 01/01/2010 to 12/31/2016, along with cancer-free controls (1:10), matched on age and sex. We identified all prescriptions dispensed from community pharmacies during the year prior to diagnosis and used the Anatomical Therapeutic Chemical (ATC) Classification system Level 3 to group prescriptions according to drug class. We conducted a parallel assessment for those diagnosed with average age-onset CRC (AAO-CRC; diagnosis at age ≥50 year). RESULTS We included 1,001 EAO-CRC cases (41.0 ± 6.1 years; 45% females), 12,989 prescriptions were filled in the year before diagnosis by 797 individuals (79.7%). Top filled drugs were antidepressants (1st; 13.1%). Drugs for peptic ulcer disease and gastroesophageal reflux disease (3rd; 6.1%) were more likely filled by EAO-CRC cases than controls (OR 1.4, 95% CI, 1.2 to 1.7) and with more frequent fills (OR 1.8, 95% CI, 1.7 to 1.9). We noted similar patterns for topical agents for hemorrhoids and anal fissures which were more likely filled by EAO-CRC cases than controls (OR 7.4, 95% CI, 5.8 to 9.4) and with more frequent fills (OR 15.6, 95% CI, 13.1 to 18.6). CONCLUSIONS We observed frequent prescription medication use in the year before diagnosis of EAO-CRC, including for drugs to treat commonly reported symptoms of EAO-CRC.

show abstract

Referral challenges for early-onset colorectal cancer: a qualitative study in UK primary care

O'Neill

Coleman

Reid

2023

BJGP Open

View full text Add to dashboard Cite

BackgroundThe incidence of early onset colorectal cancer (EOCRC), in adults aged under 50 years, has increased in several Western nations. National surveys have highlighted significant barriers to EOCRC patients accessing timely care, which may be contributing to a late stage of presentation amongst this population group.AimTo explore awareness of the increasing incidence of EOCRC, and to understand the potential barriers or facilitators faced by general practitioners (GPs) when referring younger adults to secondary care with features suspicious for EOCRC.Design & settingQualitative methodology, via virtual semi-structured interviews with seventeen GPs within Northern Ireland.MethodReflective thematic analysis was conducted with reference to Braun and Clarke’s framework.ResultsThree main themes were identified regarding awareness, diagnostic and referral challenges amongst participating GPs. Awareness challenges focused on perceptions of EOCRC being solely associated with hereditary cancer syndromes and colorectal cancer being a condition of older adults. Key diagnostic challenges centred around the commonality of lower gastrointestinal complaints and overlap in EOCRC symptoms with benign conditions. Restrictions in age-based referral guidance and a GP ‘guilt complex’ surrounding over-referral to secondary care summarised the referral challenges. Young women were perceived as being particularly disadvantaged with regards to delays in diagnosis.ConclusionThis novel research outlines potential reasons, from a GP perspective, for the diagnostic delays seen in patients with EOCRC and highlights many of the complicating factors that contribute to the diagnostic process.

show abstract

Clinical Delays and Comparative Outcomes in Younger and Older Adults with Colorectal Cancer: A Systematic Review

Cited by 3 publications

References 65 publications

Comparing Time to Diagnosis and Treatment Between Younger and Older Adults With Colorectal Cancer: A Population-Based Study

Comparing Time to Diagnosis and Treatment Between Younger and Older Adults With Colorectal Cancer: A Population-Based Study

Patterns of prescription medication use before diagnosis of early age-onset colorectal cancer: A population-based descriptive study (Preprint)

Referral challenges for early-onset colorectal cancer: a qualitative study in UK primary care

Contact Info

Product

Resources

About