Studies reveal unique challenges faced by younger patients with colorectal cancer

Younger adults with colon cancer tend to be diagnosed at a later stage and have more aggressive types of tumors. Additionally, young patients living with colorectal cancer have long-term, adverse consequences on their lives, which are different from the impact the disease has on older adults, according to two studies being presented at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco, California.

Sociodemographic and patient characteristics associated with colon cancer in adults under age 45

Colon cancer is a leading cause of cancer-related deaths in the United States and is usually associated with older adults.

We know that over the last 20 years, rates of colon cancer diagnoses have decreased 20% for patients 66 years and older. However, the rates of this cancer in those between 18 and 44 years old have increased 15% during that same period."

Kelley Chan, MD, lead study author, Clinical Scholar with ACS Cancer Programs, and fourth-year general surgery resident at Loyola University Medical Center, Chicago

To understand why colon cancer is affecting more young adults, researchers investigated sociodemographic factors and the tumor biology associated with this disease in younger adults. Using the National Cancer Data Base, a large hospital-based database that captures about three-quarters of all cancers diagnosed in the U.S., researchers compared two groups: younger adults (18-44 years) and older adults (45 years and older) diagnosed with colon cancer between 2015 and 2021. 

Study findings

There were 318,951 new cases of colon cancer diagnosed in Commission on Cancer (CoC) hospitals from 2015 to 2021. Of those, 16,974 (5.6%) were younger adults (18-44 years) and 301,977 (94.4%) were older adults. After comparing age groups, the analysis showed that a higher proportion of young adults had later-stage disease with more aggressive types of tumors. Additionally, a higher proportion of young adults with colon cancer were non-Hispanic Black (16.9%), as compared to the proportion of non-Hispanic Black Americans that make up the general U.S. population (12.1%). 

"These findings highlight the disparities in the incidence of colon cancer in this population and are consistent with previous studies that show early-onset colon cancer diagnoses are highest for non-Hispanic Black patients compared to other groups," Dr. Chan said. 

The disease in younger adults had a strong association with obesity, family history of colon cancer, inflammatory bowel disease, and symptoms, such as abdominal pain or rectal bleeding, after controlling for sociodemographic factors and other serious health conditions, the researchers found. 

"Other studies have demonstrated colon cancer in young adults has more aggressive molecular and genetic characteristics; therefore, taken together, our findings highlight the need for more research to understand the development of colon cancer in adults under age 45 and to revise risk assessments to improve prevention and screening of these cancers before they get to later stages," Dr. Chan said.

In terms of limitations, about one-quarter of the U.S. cancer population receives treatment at non-CoC-accredited hospitals and was not included in this study, which means some differences may not be accounted for based on region, race, and ethnicity. 

Emerging population perspectives: Exploring colorectal cancer in adults under age 50

For younger adults, a cancer diagnosis has many far-reaching consequences that are not well described. "Colorectal cancer has been rising in young adults and that comes with many unique circumstances," said Samantha Savitch, MD, lead study author and a fourth-year general surgery resident at the University of Michigan in Ann Arbor. "We need to recognize that colorectal cancer is impacting younger people in developmental stages of their lives and find more holistic ways to address their concerns." 

To better understand the experiences of young adults with colorectal cancer, the research team conducted interviews with 35 patients who were diagnosed with colorectal cancer before the age of 50. Participants were recruited from three academic medical centers where they were receiving cancer treatment. Participants were asked open-ended questions about the influence of a cancer diagnosis on their lives, daily challenges, and concerns about the future. 

Patients were most concerned about four areas of health and well-being: physical health, mental health, family planning, and career. Specifically, their responses revealed that infertility, anxiety, and uncertainty surrounding the diagnosis and long-term survival, and not being able to build assets, pursue higher education, or establish job security mattered most. Additionally, these concerns were not gender specific. Career, physical health, financial security, mental health, fertility, and family planning were equally important to both men and women. 

The study authors hope this understanding of patient concerns will spur additional conversations about the comprehensive needs of younger patients and spark interest in creating programs such as fertility counseling, financial support, and mental health counseling that address their unique challenges.

"These aspects of cancer care are rarely discussed, so it is important to acknowledge that patients care about fertility and family planning, their career aspirations, building assets -; all things they must put on hold because of their cancer diagnosis," Dr. Savitch said. "This goes beyond just colorectal cancer; cancer across the board is increasing in younger patients. There are a lot of patients experiencing similar challenges, so we need more research to better understand these issues in patients with colorectal cancer as well as other cancers and, ultimately, to restructure our comprehensive cancer programs to make sure we are treating the patient and not just the disease."

The major limitation of the study is that this type of study, called convenience sampling, may bias in the results. 

Co-authors of the study on the sociodemographic and patient characteristics associated with colon cancer are Bryan Palis, MA; Joseph Cotler, PhD; Xuan Zhu, MPH; Anani Hoegnifioh, MS; and Clifford Y. Ko, MD, FACS.

Kelley Chan, MD, is supported through the American College of Surgeons Clinical Scholars Grant.

Co-authors of the study on emerging population perspectives in colorectal cancer are Sarah Bradley, PhD, MPH, CPH; Maedeh Marzoughi, BS; Claire Ashmead-Meers, MSc; Crystal A. Vitous, MA, MPH; and Pasithorn A. Suwanabol, MD, MS, FACS.

The study was supported by the Rogel Cancer Center at the University of Michigan, Ann Arbor.