In a Canadian retrospective cohort study reported in JAMA Network Open, Castelo et al found that a greater interval between date of presentation and treatment initiation was not associated with an increased risk of poorer survival among patients with colorectal cancer diagnosed before age 50.
The study included 5,026 patients diagnosed with colorectal cancer before age 50 years in Ontario between 2007 and 2018. Administrative and billing codes were used to identify the number of days between the date of first presentation and treatment initiation (overall interval).
Key Findings
Among the 5,026 patients, median age was 44.0 years (interquartile range [IQR] = 40.0–47.0 years) and 1,266 (25.2%) had metastatic disease. The median overall interval was 108 days (IQR = 55–214 days), or 15.4 weeks IQR = 7.9–30.6 weeks). Patients with metastatic colorectal cancer had a shorter median overall interval (83 days, IQR = 39–183 days) vs those with less advanced disease. Among all patients, 5-year overall survival was 69.8% (95% confidence interval [CI] = 68.4%–71.1%) and 5-year cause-specific survival was 78.2% (95% CI = 77.0%–79.4%).
In adjusted Cox proportional hazards models including all patients, overall interval lengths of < 6 weeks and 6 to 12 weeks were associated with poorer outcomes compared with an interval length of 12 to 18 weeks for both overall survival (hazard ratio [HR] for < 6 weeks = 1.73, 95% CI = 1.46–2.06; HR for 6–12 weeks = 1.21, 95% CI = 1.03–1.43) and cause-specific survival (HR for < 6 weeks = 2.06, 95% CI = 1.67–2.55); HR for 6–12 weeks = 1.31, 95% CI = 1.06–1.61). Overall intervals longer than 18 weeks were not associated with significantly worse overall survival or cause-specific survival compared with intervals of 12 to 18 weeks. As noted by the investigators, the poorer outcomes with a shorter overall interval likely reflected the tendency for patients with metastatic disease or urgent presentations to have a shorter time to treatment.
The investigators concluded: “In this cohort study of 5,026 patients with [colorectal cancer] aged younger than 50 years … in Ontario, time from presentation to treatment was not associated with … poor survival. These results suggest that targeting post-presentation intervals may not translate to improved outcomes on a population level.”
Nancy N. Baxter, MD, PhD, of the School of Population and Global Health, University of Melbourne, Australia, is the corresponding author for the JAMA Network Open article.
Disclosure: This study was supported by the Ontario Ministry of Health and Ministry of Long-Term Care and Canadian Institutes of Health Research. For full disclosures of the study authors, visit jamanetwork.com.
