Rx guidelines don’t benefit young rectal cancer patients, physicians ‘should take notice’ — 5 study insights

A new study, published in Cancer, found patients under the age of 50 with stage 2 or stage 3 rectal cancer don’t seem to benefit from guideline-driven treatment recommendations compared to older patients who do benefit in terms of overall survival.

The study included data from patients diagnosed with rectal cancer between 2004 and 2014, and comprised 5,591 patients younger than 50, and 19,348 from ages 50 to 75.

Here are the key takeaways:

1. For stage 2 and 3 disease, younger patients are more likely to receive NCCN guideline-driven care...but it does not seem to affect their survival, the researchers said. The younger patients had better short-term mortality and long-term survival rates compared to the older patients.

2. “The 30-day mortality rate was 2 percent for older patients and 0.2 percent for younger patients; the 90-day mortality rate was 3.7 percent for older patients and 0.5 percent for younger patients,” the researchers said.

3. The difference was more pronounced when looking at three-, five- and 10-year survival rates, which persisted independently for stage 1, 2 and 3 disease. Among older patients, with stage 2 or 3 disease, 14 percent received stage-appropriate treatment at five years, with the survival benefit lasting 10 years.

4. The guideline-driven care didn’t give a survival benefit among younger patients with stage 2 or 3 disease. The researchers said the date suggest patients younger than 50 with rectal cancer differ at presentation in comparison with middle-aged patients.

5. The researchers said the younger patients tend to be female, belong to minority groups and lack insurance. They also are more likely to present with a higher stage of disease and have worse tumor characteristics than the older patients.

In an editorial published alongside the study, Matthew Kalady, MD, of the Cleveland Clinic said the study should "open the eyes" of all involved in the treatment of rectal cancer.

"We need to evaluate why this is happening and explore the unique characteristics that define this population and potential differences in comparison with older age rectal cancers," he said.

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