Early symptom patterns among young Medicaid-insured individuals with colorectal cancer: A population-based analysis.

Abstract

24 Background: Survey and anecdotal data from patients with early-onset colorectal cancer (EOCRC) suggest that they are more likely to have symptoms ignored or to see multiple providers prior to diagnosis compared to older patients. We aimed to assess this trend in a population-based study. Methods: We conducted a population-based cohort study from the Ohio Cancer Incidence Surveillance System linked to Ohio Medicaid claims. We included individuals aged 18-65 and diagnosed with CRC between January 2017 and December 2020 with at least 1 year of continuous enrollment. We selected age-matched cancer-free controls from the same population using 5:1 nearest neighbor Mahalanobis distance matching without replacement. We assessed symptoms based on ICD-10 codes documented in claims data at monthly intervals in the year pre-diagnosis, including CRC-related (anemia, abdominal pain and gastrointestinal (GI) bleeding) and “control” (hypertension and musculoskeletal pain) symptoms. We calculated rate ratios (RRs) as the monthly rate of symptom claims among CRC patients divided by the rate in controls, stratified by age group (<50 vs 50–65 years). Results: 1354 CRC cases (N=359 aged <50; N=995 aged 50–65) and 6770 controls were included. 51.9% were males, with a median age of 43 and 58 years for the <50 and 50-65 groups. In the EOCRC group, anemia rates began rising significantly 6 months pre-diagnosis with a RR of 2.01 (95% CI: 1.25–3.13, p<0.001), increasing to 4.52 (3.41–5.98, p<0.001) at 1 month. In comparison, the 50–65 group had lower RRs at the same timepoints, with a more modest increase from 1.29 (1.00–1.65, p=0.05) to 2.41 (2.05–2.83, p<0.001). Abdominal pain in the EOCRC group had RRs of 1.23 (1.00–1.50, p=0.05), 1.33 (1.10–1.61, p<0.001), and 2.23 (1.92–2.59, p<0.001) at 3, 2, and 1 months pre-diagnosis, respectively, versus 0.83 (0.71–0.96, p=0.01), 1.04 (0.92–1.18, p=0.51), and 1.79 (1.62–1.97, p<0.001) in older patients. For GI bleeding, people with EOCRC had markedly higher RRs: 2.87 (1.71–4.70, p<0.001) at 6 months, peaking at 9.38 (6.99–12.72, p<0.001) at 1 month. The older group had RRs of 1.16 (0.80–1.64, p=0.42) and 5.16 (4.37–6.09, p<0.001) at the same timepoints. In contrast, hypertension and musculoskeletal pain RRs remained below 1.0 at all timepoints in the <50 group indicating no rise prior to diagnosis and confirming a specific increase in CRC-related symptoms only rather than generalized healthcare use. Conclusions: EOCRC patients exhibited more pronounced and earlier symptoms compared to older adults with CRC and to controls. The magnitude of symptom escalation suggests a prolonged pre-diagnostic phase during which symptoms were not acted upon, confirming data of delayed diagnostic opportunities in younger individuals. This emphasizes the need to improve awareness and diagnostic strategies in younger individuals to assure timely detection and optimize outcomes.