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Long-Term Survival in Young Adults With Colorectal Cancer: A Population-Based Study

Forbes, Shawn S. M.D.1,2; Sutradhar, Rinku Ph.D.3; Paszat, Lawrence F. M.D.2,3; Rabeneck, Linda M.D.2,3,4; Urbach, David R. M.D.1,2,3,5; Baxter, Nancy N. M.D.1,2,3,6

Diseases of the Colon & Rectum: July 2010 - Volume 53 - Issue 7 - p 973-978
doi: 10.1007/DCR.0b013e3181cf8341
Original Contribution
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PURPOSE: This study compares the long-term survival of young adults with colorectal cancer who lived a minimum of 5 years after diagnosis with a cancer-free control population.

METHODS: A population-based study was conducted using cancer registry and administrative data. Persons aged 20 to 44 years in whom colorectal cancer was diagnosed between 1992 and 1999 and who lived at least 5 years after diagnosis were identified using the Ontario Cancer Registry. Patients with colorectal cancer were matched 1:5 to randomly selected controls (who were cancer free at the corresponding date of diagnosis) by use of the Registered Persons Database of Ontario based on age, sex, and geographic location. Time-to-death was compared between patients with colorectal cancer and controls by use of Kaplan-Meier estimates and Cox proportional hazard regression.

RESULTS: Nine hundred seventeen young adults with colorectal cancer who lived at least 5 years after diagnosis and 4585 controls were identified. The median follow-up after achieving 5-year survivor status was 6.2 years; 9.5% (87) of patients with colorectal cancer died compared with 1.2% (56) of controls (P < .0001). 62.1% of deaths In the colorectal cancer patient population were attributed to malignant disease. Colorectal cancer patients were significantly more likely to die over time than controls (hazard ratio, 8.2; 95% CI (5.8, 11.6)). Those patients with no evidence of disease recurrence within the first 5 years after diagnosis also remained at an increased risk of death (hazard ratio, 2.0, 95% CI (1.2, 3.6)).

CONCLUSIONS: Young adult 5-year survivors of colorectal cancer remain at a higher risk of long-term death than age-matched controls.

1 Department of Surgery, University of Toronto, Toronto, Ontario, Canada

2 Department of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada

3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

4 Department of Medicine, University of Toronto, Toronto, Ontario, Canada

5 Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

6 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada

This work was supported by a Canadian Institutes of Health Research Operating Grant. Dr. Forbes was supported by an American Society of Colon and Rectal Surgeons, General Surgery Resident Research Initiation Grant. Dr. Paszat is supported by a clinician scientist salary from the Ministry of Health and Long-term Care of Ontario.

Financial Disclosures: None reported.

This study was conducted at the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Minneapolis, MN, May 15 to 19, 2010.

Correspondence: Shawn Forbes, M.D., St. Michael's Hospital, Cardinal Carter Wing, 16th Floor, Room 040, 30 Bond St, Toronto, ON, M5B 1W8 Canada. E-mail: shawn.forbes@utoronto.ca

© The ASCRS 2010