A. Stetson1, J.H. Aldrink2, M. Parrish4, A. Rustad3, S. Srivatsa2, R. Gold1, S. Polites4, H. Rice3, E. Tracy3, A. Gasior2, S. Mansfield2, D.B. Cameron1 1Massachusetts General Hospital, Pediatric Surgery, Boston, MA, USA 2Nationwide Children’s Hospital, Pediatric Surgery, Columbus, OH, USA 3Duke University Medical Center, Durham, NC, USA 4Mayo Clinic, Rochester, MN, USA
Introduction: While adolescent and young adult (AYA) colorectal cancer (CRC) is rare, the incidence is increasing. AYA patients with CRC are known to experience worse outcomes, which may be in part due to care spanning pediatric and adult centers. This study aims to characterize the scope of care surrounding AYA colorectal cancer.
Methods: A multi-institutional retrospective cohort study across 4 pediatric institutions with heterogenous relationships to adult hospitals was performed. Patients 10-21 years of age diagnosed with CRC between 2020-2022 were included. Variables of interest included patient demographics, hospital demographics, initial presentation, and surgical and medical management. Fisher’s exact testing was used to compare categorical variables.
Results: Thirty-four patients were identified. Median age at diagnosis was 19.0 years (IQR 16.2, 21.2). Twenty-one (62%) patients had colon cancer, and 13 (38%) had rectal cancer. Over half the patients (20, 59%) received care at an adult institution, one third (10, 29%) received care at a children’s hospital within an adult hospital and the remainder (4, 12%) at a free-standing children’s hospital. All sites had access to collaboration with an adult CRC surgeon and a multi-disciplinary tumor board. Only 9 (26%) patients were presented at either an adult or pediatric tumor board. Thirty-two patients (94%) underwent surgical resection. The surgery was performed by a pediatric surgeon for 7 (22%) patients, an adult general surgeon for 4 (13%) patients, an adult colorectal surgeon for 19 (59%) patients, and pediatric and adult surgeon team for 2 (6%) patients. There were no differences in surgical approach (laparoscopic v. open v. robotic) based on surgeon specialty (p>0.99) or hospital type (p=0.406). Six patients (18%) had < 12 nodes sampled, with no significant difference based on surgeon specialty (p=0.296). Median follow-up was 2.2 years (IQR 1.57-6.90). At most recent follow up, 10 (47.6%) patients with colon cancer and 7 (53.8%) patients with rectal cancer were alive with no evidence of disease, 4 (19.0%) patients with colon cancer and 1 (7.7%) patient with rectal cancer were alive with disease, 3 (9%) had unknown status, and 6 (28.6%) colon and 3 (23.1%) rectal cancer patients were deceased, 5 (71%) of whom died from disease.
Conclusion: Adolescent and young adult patients with CRC represent a unique and vulnerable population. There is variation in care models which may represent opportunities for enhanced collaboration across the pediatric and adult providers to improve outcomes for young patients with rare solid tumors.