Early onset colorectal cancer: Challenges across the cancer care continuum

AlZaabi, Adhari; AlHarrasi, Amna; Al-Musalami, Atika; AlMahyijari, Nawal; Hinai, Khalid Al; ALAdawi, Humaid; Al-Shamsi, Humaid O.

doi:10.1016/j.amsu.2022.104453

Cited by 18 publications

(19 citation statements)

References 94 publications

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“… 51 54 Given the rising incidence of EOCRC, framed by the protracted diagnostic phases and late-stage diagnoses of this patient population, strategies such as regular screening from age 40 years and broad use of faecal occult blood test have been proposed as cost-effective means of bypassing age bias and assuring an early EOCRC diagnosis. 52 55 …”

Section: Discussionmentioning

confidence: 99%

“…The implications of this advocacy are complex 50. Previous work by this research team and others has identified a number of current systemic and clinical healthcare-led confounders to diagnosis: lack of experience with EOCRC patients; the broad symptom nature of the disease, especially in its early presentation; the absence of EOCRC-specific screening policies and evidence-based guidelines; and broader issues related to continuity-of-care within and across health services and quality of interpersonal care 51 52…”

Section: Discussionmentioning

confidence: 99%

“…Established evidence of the rising EOCRC incidence is generating interest from policy-makers and practitioners,1 however, the lag in EOCRC-specific clinical guidance53 may be a source of ongoing frustration for EOCRC patients 5 47 51. There are patients for whom the risk of EOCRC is so low that colonoscopy or flexible sigmoidoscopy cannot be economically justified, regardless of the repetitive nature of the symptoms 50 52. There are also circumstances in which clinicians are resistant to wasting resources by referring younger people for colonoscopy or flexible sigmoidoscopy, even when those patients present with traditional CRC symptoms or have known cancer syndromes or familial CRC 51 54.…”

Section: Discussionmentioning

confidence: 99%

“…There are also circumstances in which clinicians are resistant to wasting resources by referring younger people for colonoscopy or flexible sigmoidoscopy, even when those patients present with traditional CRC symptoms or have known cancer syndromes or familial CRC 51 54. Given the rising incidence of EOCRC, framed by the protracted diagnostic phases and late-stage diagnoses of this patient population, strategies such as regular screening from age 40 years and broad use of faecal occult blood test have been proposed as cost-effective means of bypassing age bias and assuring an early EOCRC diagnosis 52 55…”

Section: Discussionmentioning

confidence: 99%

“…A growing body of grey and peer-reviewed literature supports EOCRC patients’ concerns with age bias,51 however, clinical guidelines do not as yet distinguish EOCRC from CRC in older populations52 and it can be challenging for medical practitioners to identify and screen for EOCRC in average-risk individuals 50 66. Researchers, policy makers and healthcare professionals may benefit from engagement with EOCRC patient online communities and consumer advocates to comprehend youthfulness as a barrier to timely diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Things I need you to know: a qualitative analysis of advice-giving statements in early-onset colorectal cancer patients’ personal accounts published online

Lamprell

Pulido²,

Arnolda³

et al. 2023

BMJ Open

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ObjectivePeople with early-onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) before the age of 50, now constitute a significant patient population. In empirical and grey literature EOCRC patients report unsatisfactory experiences of care, especially in relation to protracted intervals from first help-seeking to diagnosis. This study is the first to investigate EOCRC patients’ perspectives on ways to improve experiences of care. The objective is to provide foundational knowledge for the development of EOCRC-specific patient-reported experience measures (PREMs).DesignThe study was designed as qualitative Internet Mediated Research, involving a thematic analysis of unsolicited narratives recounting personal experiences of EOCRC care. We examined advice-giving statements in 120 online texts written by EOCRC patients and survivors.SettingThe Internet is the broad research setting. The host websites of three prominent charitable CRC support organisations were selected as specific research sites: Bowel Cancer Australia, Bowel Cancer UK and Bowel Cancer New Zealand.ResultsWe found that 90% of texts comprised statements of advice to new patients about the importance of self-advocacy in achieving quality care. Four key contexts for self-advocacy were identified: (1) accessing relevant diagnostic services; (2) driving diagnostic investigations when symptoms are not resolved; (3) involvement in treatment decision-making and (4) proactivity about preferred outcomes. Over 30% of advice-giving texts also directed statements of advice to healthcare providers, indicating that their youthfulness had been a barrier to timely diagnosis.ConclusionHealthcare barriers to, and facilitators of, patient self-advocacy may be indicators of quality EORC care. There is a need for greater awareness of the impact of age bias on the responsiveness of clinicians and healthcare services in EOCRC care. Our findings support the development of EOCRC-specific PREMs that can guide age-appropriate policy and practice for this newly identified patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Things I need you to know: a qualitative analysis of advice-giving statements in early-onset colorectal cancer patients’ personal accounts published online

Lamprell

Pulido²,

Arnolda³

et al. 2023

BMJ Open

View full text Add to dashboard Cite

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Mortality‐to‐incidence ratio of early‐onset colorectal cancer in high‐income Asian and Middle Eastern countries: A systemic analysis of the Global Burden of Diseases Study 2019

Ramadan,

Alsiary,

Aboalola

2023

Cancer Medicine

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BackgroundThe incidence of early‐onset colorectal cancer (EO‐CRC) has been consistently rising leading to a significant cancer burden among younger adults in Asian and Middle Eastern high‐income countries. The study aims to investigate the survival outcomes of EO‐CRC among high‐income Asian and Middle Eastern populations from 1990 to 2019 using the mortality‐to‐incidence ratio, with a focus on examining the differences in gender.MethodsThis is a systematic analysis of the Global Burden of Disease (GBD) 2019 study. We include individuals aged 15 to 49 years old in high‐income Asian and the Middle Eastern countries. The colorectal cancer mortality‐to‐incidence ratio (MIR) was calculated for both genders by dividing the age‐specific mortality rate per 100,000 for colorectal cancer by the age‐specific incidence rate per 100,000 for each nation in the sample for a given year.ResultsAn overall decline in male and female MIR was observed from 1990 to 2019 in Asian and Middle Eastern countries. Ten out of thirteen Asian and Middle Eastern countries had a higher female MIR compared to their male counterparts. The global male MIR was found to be significantly higher than that of female (p‐value 0.008, coefficient estimate: 1.51). In Middle Eastern countries, Saudi Arabia had a significantly higher female MIR compared to their male counterparts (p < 0.0001, coefficient estimate: 12.65).ConclusionThis research addresses the knowledge gap concerning gender‐based differences in EO‐CRC survival outcomes in high‐income Asian and Middle Eastern countries, providing insights into the factors influencing these disparities in these regions. Policymakers should focus on developing targeted prevention and treatment programs for women, and addressing cultural and social barriers that may prevent women from seeking timely medical care.

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