Health-Related QOL Differences Are Observed for Young Adults With CRC

Amanda Bloomer, PhD

Following a diagnosis of colorectal cancer (CRC), young adult patients reported experiencing better global quality-of-life (QOL) outcomes compared with adults with average and late onset disease, according to findings from the ColoCare study (NCT02328677). However, this patient population experienced worse financial hardships, as well as worse nausea/vomiting, according to Amanda Bloomer, PhD, who presented the data at the 2023 AACR Annual Meeting.

Findings demonstrated that younger adults aged 18 to 39 years (n = 87) had better physical function at baseline (P = .014) as well as at 24 months (P = .044) and had less fatigue (P = .027) compared with adults with average onset disease (n = 873) aged 40 to 64 years. Differences were also seen between the age groups with younger adults reporting better global QOL scores at 24 months compared with adults with average onset disease (P = .004) and adults with late onset disease (n = 712) aged 65 years or older (P = .001).

“I’m hoping this gives us some insight into what young adults are experiencing when they are diagnosed [with CRC],” said Bloomer, who added that this is a disease with growing incidence and mortality rates among young adults. “It’s not a common disease. [Patients in this age group] are not likely to know somebody who has CRC, so it helps inform what type of support we need to have in place for this population.”

Additionally, reports demonstrated young adults experienced less fatigue at 24 months (P = .007), and better physical function at baseline (P < .001), 3 months (P = .019), 6 months (P = .015), and 24 months (P < .001) vs adults with late onset disease.

However, young adults reported worse nausea/vomiting at 3 months (P < .001), 6 months (P < .001), and 12 months (P = .006), as well as worse financial difficulties at baseline (P < .001), 3 months (P = .001), 6 months (P < .001), and 12 months (P = 0.002) compared with adults with late onset disease. Worse social function, emotional function, and appetite loss were also reported.

In an interview with OncLive^®, Bloomer, who is a senior research specialist at Moffitt Cancer Center, highlighted the growing need for more research for this growing patient population and the age-specific findings that were seen in the ColoCare trial.

OncLive: What was the rationale for investigating this topic?

Bloomer: We looked at health-related QOL among newly diagnosed young adults with CRC and the rationale for that is there is a rising incidence in patients with CRC under the age of 50 [years]. That has been going [up] 3% to 6% or so every year, whereas [for those] over 50 [years], we’re seeing a decline because of screening. The younger adult population has more critical needs that are a bit unique, so we are looking at those [who are aged] 18 to 39 [years] who have been diagnosed with CRC. There are many unmet needs in this group because [the rise in CRC] is recent, [within] the past 2 decades or so.

We have a lot of facts [demonstrating] that the incidence [of] mortality is rising in this group, but we don’t have a good picture of the QOL that these patients experience and how it compares with older adults who are diagnosed with CRC.

Were there any previous investigations that led to this research?

I work on a study called ColoCare, [which] was a U01-supported consortium that was [conducted] throughout the United States and 1 international site. [For the trial], we got consent from patients at diagnosis or baseline who had CRC of all ages, and that [population] provided the foundation for this study. It’s hard to study young adults because even with incidence rising, we still have a small number of patients we’re seeing for research, epidemiological, and behavioral studies. The ColoCare study provided us with the number of patients we need to do this kind of study—it set the stage for it to be able to happen.

What methods were used for your research?

[Once] patients [consent] at diagnosis, which counts as baseline, we draw blood [and] tissue samples that we collect at diagnosis/baseline, 3 months, 6 months, 12 months, and 24 months. We follow our patients for 5 years so that we get survival data, [monitor] their clinical progression, [and] see if there’s any recurrence.

What findings did you present at the 2023 AACR Annual Meeting?

To start with the findings that we expected, we used the European Organization for Research and Treatment of Cancer [(EORTC), which] is a European cancer questionnaire for assessing QOL [to collect these] data. There are 9 symptom scales, 5 functioning scales, and then a global QOL scale. One of those scales is physical functioning and as we expected, younger adults had better physical functioning than older adults mostly because of age-related [factors] and fewer comorbidities.

However, we saw that young adults had worse financial toxicity, which is expected as this group tends to not have an established wealth, so the finances associated with cancer care hit harder.

Things that were less expected [were] nausea, vomiting, and appetite loss were significant in young adults—they had significantly worse symptoms [from] baseline through 12 months. We’re hypothesizing that could be [because of] more aggressive treatment that’s typically seen in younger adults, or it could be [because of] specific drugs. We’re going to dive into that a little bit deeper in the future.

What additional next steps would you like to take?

We want to look into the treatment and see if there’s any association in terms of what’s causing the nausea/vomiting. EORTC is a validated questionnaire that’s given and so there are clinically important thresholds that have been established…. [The main next steps are that] we’re going to compare [outcomes in] our young adult [population] with those clinically important thresholds and see what proportion of our patients are hitting that line and where there needs to be some intervention with clinical care so that we can better inform treatment.

The main takeaway is that there’s a lot that needs to be done for young adults with CRC. There’s a lot that is still unknown both on the behavioral and epidemiological side that we really need to look further into.

Reference

Bloomer AM, Trujillo G, Gomez M, et al. Health-related quality of life among newly diagnosed young adult colorectal cancer patients: results from the ColoCare Study. Cancer Res. 2023;83(suppl 7):3049. doi:10.1158/1538-7445.AM2023-3049