A longer time from presentation to treatment is not associated with significantly adverse survival among patients with colorectal cancer (CRC) aged younger than 50 years, according to a study in JAMA Network Open.

The population-based cohort study identified patients aged 15 to 49 years who were diagnosed with CRC.

The exposure of interest was the number of days from first presentation to treatment initiation. Outcomes included overall survival (OS), which was the number of months from treatment initiation to death or until December 31, 2019, as well as cause-specific survival (CSS).

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Cox proportional hazards models were used to assess the associations of longer overall intervals with OS and CSS; and, the analysis was conducted from December 2019 to December 2022.

The cohort included 5,026 adults, with a median age of 44.0 years (IQR, 40.0-47.0 years), and 48.0% were women. Among the participants, 1,266 (25.2%) presented with metastatic disease and 1570 (31.2%) with rectal cancer. A lower-urgency subset included 2,548 patients (median age, 45.0 [IQR, 41.0-47.0] years; men, 50.3%).

The median overall interval was 108 days (IQR, 55-214; 15.4 weeks [IQR, 7.9-30.6]). In the lower-urgency subset, the median overall interval was 141 days (IQR, 85-246; 20.1 weeks [IQR, 12.1-35.1]), a difference that was statistically significant (P <.001).

Disease stage was associated with overall interval length. Patients who had stage I CRC had a median of 152 days (IQR, 87-261) to treatment vs stage II CRC (median, 108 days) and stage III CRC (median, 107 days). Patients who had metastatic CRC had the shortest median overall intervals (83 days [IQR, 39-183]).

A total of 1,574 patients died (31.3%), of whom 1041 died due to CRC (66.1%). The 5-year OS was 69.8% (95% CI, 68.4%-71.1%), and the 10-year OS was 63.0% (95% CI, 61.5%-64.6%). The 5-year CSS was 78.2% (95% CI, 77.0%-79.4%), and the 10-year CSS was 75.0% (95% CI 73.7%-76.4%). Patient survival decreased with advancing stage of disease.

In the spline regression analysis, younger adults with overall intervals less than the median (<108 days) had worse OS. Patients with longer times to treatment had a comparable OS to those with median overall intervals. A longer overall interval was not associated with adverse survival for CSS.

In the lower-urgency subset of patients, multivariable Cox models yielded similar findings to the overall analysis. The overall interval lengths of 18 to 24 weeks and 24 to 30 weeks were associated with comparable outcomes vs interval lengths of 12 to 18 weeks for OS (18-24 weeks: HR, 0.90; 95% CI, 0.63-1.28; 24-30 weeks: HR, 0.83; 95% CI, 0.56-1.24) and CSS (18-24 weeks: HR, 0.85; 95% CI, 0.53-1.36; 24-30 weeks: HR, 1.08; 95% CI, 0.66-1.75).

Limitations include identification of the date of first presentation using an algorithm based on administrative and billing codes developed for Ontario databases. In addition, the analysis did not evaluate the interval between symptom onset and presentation, and other factors such as patient knowledge, reluctance to seek help, fear or denial, and financial concerns were not assessed.

“These findings suggest that postpresentation delays in younger adults with colorectal cancer do not appear to be associated with worse outcomes,” study authors concluded.


Castelo M, Paszat L, Hansen BE. Analysis of time to treatment and survival among adults younger than 50 years of age with colorectal cancer in Canada. JAMA Netw Open. Published online August 3, 2023. doi:10.1001/jamanetworkopen.2023.27109

This article originally appeared on Gastroenterology Advisor