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Treatment patterns and survival differ between early-onset and late-onset colorectal cancer patients: the patient outcomes to advance learning network

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Abstract

Purpose

Our objective was to describe differences in treatment patterns and survival between early-onset (< 50 years old) and late-onset colorectal cancer (CRC) patients in community-based health systems.

Methods

We used tumor registry and electronic health record data to identify and characterize patients diagnosed with adenocarcinoma of the colon or rectum from 2010 to 2014 at six US health systems in the patient outcomes to advance learning (PORTAL) network. We used logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing the distribution of tumor characteristics and treatment patterns in early-onset versus late-onset CRC. Cox regression models were used to estimate adjusted hazard ratios (HRs) and CIs comparing survival between early- and late-onset CRC patients.

Results

There were 1,424 early-onset and 10,810 late-onset CRC cases in our analyses. Compared to late-onset CRC, early-onset CRC was significantly associated with advanced-stage disease, high-grade histology, signet ring histology, and rectal or left colon location. After adjusting for differences in tumor and patient characteristics, early-onset patients were more likely than late-onset patients to have > 12 lymph nodes examined (OR 1.60, CI 1.37–1.87), to receive systemic therapy (chemotherapy or immunotherapy) within 6 months of diagnosis (OR 2.84, CI 2.40–3.37), and to have a reduced risk of CRC-specific death (HR 0.66, CI 0.56–0.79).

Conclusions

Early-onset CRC is associated with aggressive tumor characteristics, distal location, and systemic therapy use. Despite some adverse risk factors, these patients tend to have better survival than older onset patients.

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Acknowledgments

This study used the infrastructure developed by the PORTAL (Patient Outcomes Research to Advance Learning) Network, a consortium of three integrated delivery systems (Kaiser Permanente, HealthPartners, and Denver Health) and their affiliated research centers. Research reported in this publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (CDRN-1306-04681 Phase II). The statements in this publication are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee.

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Authors and Affiliations

  1. Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA

    Andrea N. Burnett-Hartman, J. David Powers, Andrew T. Sterrett & Heather Spencer Feigelson

  2. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA

    Jessica Chubak

  3. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Douglas A. Corley

  4. Department of Surgical Quality and Outcomes, Kaiser Permanente Southern California, Pasadena, CA, USA

    Nirupa R. Ghai

  5. Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA

    Carmit K. McMullen

  6. HealthPartners Institute, Bloomington, MN, USA

    Pamala A. Pawloski

  7. Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Suite 200, Aurora, CO, 80014, USA

    Andrea N. Burnett-Hartman

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  1. Andrea N. Burnett-Hartman
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  2. J. David Powers
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  9. Heather Spencer Feigelson
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Correspondence to Andrea N. Burnett-Hartman.

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This study was conducted in accordance with the ethical standards of the institutional review board at Kaiser Permanente Colorado and with the 1964 Helsinki declaration and its later amendments.

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Burnett-Hartman, A.N., Powers, J.D., Chubak, J. et al. Treatment patterns and survival differ between early-onset and late-onset colorectal cancer patients: the patient outcomes to advance learning network. Cancer Causes Control 30, 747–755 (2019). https://doi.org/10.1007/s10552-019-01181-3

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