Younger rectal cancer patients face delays in diagnosis, treatment

Reuters Health Information: Younger rectal cancer patients face delays in diagnosis, treatment

Younger rectal cancer patients face delays in diagnosis, treatment

Last Updated: 2015-11-12

By Laura Newman

NEW YORK (Reuters Health) - Patients younger than age 50 with rectal cancer live with their symptoms longer before they get medical care and experience delays in treatment, researchers report. However, stage at diagnosis and five-year survival was not adversely impacted by the delays.

"What we are really saying is that if a young person has blood in their stool, they should not ignore it or assume that it is hemorrhoids," said Dr. Neil H. Hyman in a telephone interview with Reuters Health.

"There's no disputing that with colorectal cancers, early diagnosis is better," he added. However, the study suggests that "these cancers are in some way different and that patients do not suffer adverse consequences," said Dr. Hyman, the study's senior author and Section Chief of Colorectal Surgery at the University of Chicago Hospitals.

In a retrospective case-control study, Dr. Hyman and colleagues compared 56 patients diagnosed with rectal cancer between 1997 and 2007, before age 50, and 56 controls diagnosed after age 50. Patients and controls were matched by gender and date of diagnosis.

As reported online November 3 in the American Journal of Surgery, there was nearly a 7-fold difference in the interval from symptom onset to treatment in patients under vs over age 50 (217 vs 29.5 days; p<0.0001), largely attributed to delays in seeing the initial physician. (The interval from symptom onset to initial presentation to a healthcare provider was 121 days in the under-50 group vs 21 days in the older patients; p<0.0001).

However, no impact was seen in outcome measures, the authors reported. American Joint Committee on Cancer staging "was not significantly different amongst the two groups, with Stage III disease being the most common stage in both groups," according to the paper. "Additionally, the five-year survival was similar in patients under 50 and over age 50 (64 vs 71% respectively)."

"This is a relatively small study," Dr. Hyman said. Asked whether the study lends support for colorectal cancer screening in people younger than age 50, Dr. Hyman explained that a far more comprehensive economic analysis, including evaluation of false positives, and harms would be imperative.

Dr. Dennis Ahnen, a colorectal cancer researcher at the University of Colorado Denver, commented by email to Reuters Health, "The strengths of the paper are that it addresses an important and timely topic (the increasing risk of young-onset rectal cancer) and that it tries to examine the relationship of delay in diagnosis in young versus older patients with colorectal cancer."

But, he cautioned, "The failure to find a statistical difference in stage at presentation and survival could be due to a type II error. If the series was larger, these (outcomes) might have been statistically, as well as clinically significant." Furthermore, he added: "It is a selected series from a tertiary referral center so there is a real concern of referral bias."

Dr. Hyman agreed that a type II error was possible, "although this was not the central aspect of this work."

"We all know that early diagnosis is important for cancer prognosis," he said. "Whether the study was not large enough to detect small differences in stage or prognosis or other factors are at work, it is still true that it is always better to be diagnosed sooner rather than later. I certainly would not conclude that this does not matter - it may be that these young folks would have done even better than they did if only diagnosed earlier."


Am J Surg 2015.

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