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Background: The incidence of colorectal cancer (CRC) is increasing among young adults. We sought to report on patient and disease characteristics, treatment practice patterns and outcomes in this population. Methods: We conducted a retrospective cohort study using administrative health data from the Alberta Cancer Registry (2004-2015), including demographic and tumour characteristics, and treatment received. Outcome measures included overall and cancer-specific deaths. We used Cox regression and Kaplan--Meier curves to assess for factors associated with survival. Results: We included 18 070 patients with CRC (n = 1583 [8.8%] < 50 yr, n = 16 487 [91.2 %] [supérieur ou égal à] 50 yr). Younger patients were more likely to present with locally advanced disease (21.0% v. 18.0%, p < 0.0001), stage III (16.4 % v. 14.6%, p < 0.0001) or metastatic (16.7% v. 13.8%, p < 0.0001) involvement. Younger patients were more likely to receive surgery (87.2% v. 80.9%, p < 0.0001), chemotherapy (59.6% v. 34.1%, p < 0.0001) or radiation therapy (49.5% v. 37.2%, p < 0.001). At 5 years, overall and cancer-specific survival was better among younger patients than older patients (30.6% v. 51.5% overall deaths, 27.5% v. 38.4% cancer-specific deaths, p < 0.0001). Conclusion: Despite higher stage and higher grade disease, young patients with CRC had more favourable oncologic outcomes than stage-matched older patients, which may be related to younger patients receiving more aggressive treatment. Further investigation should focus on optimal treatment patterns for young patients with CRC. Contexte : L'incidence du cancer colorectal (CCR) est en hausse chez les jeunes adultes. Nous avons voulu faire le point sur les caractéristiques de la patientèle et de la maladie, sur les pratiques thérapeutiques et leur issue chez cette population. Méthodes : Nous avons procédé à une étude de cohorte rétrospective à partir des données de santé administratives de l'Alberta Cancer Registry (2004-2015), incluant les caractéristiques démographiques et les propriétés des tumeurs, de même que les traitements administrés. Les paramètres mesurés incluaient la mortalité globale et spécifique au cancer. Nous avons utilisé le modèle de régression de Cox et la courbe de Kaplan--Meier pour évaluer les facteurs associés à la survie. Résultats : Nous avons inclus 18 070 cas de CCR (n = 1583 [8,8 %] < 50 ans, n = 16 487 [91,2 %] [supérieur ou égal à] 50 ans). Les patients plus jeunes étaient plus susceptibles de souffrir d'une maladie localement avancée (21,0 % c. 18,0 %, p < 0,0001), de stade III (16,4 % c. 14,6 %, p < 0,0001) ou métastatique (16,7 % c. 13,8 %, p < 0,0001). Les patients plus jeunes étaient plus susceptibles d'être traités par chirurgie (87,2 % c. 80,9 %, p < 0,0001), chimiothérapie (59,6 % c. 34,1 %, p < 0,0001) ou radiothérapie (49,5 % c. 37,2 %, p < 0,001). Après 5 ans, la survie globale et spécifique au cancer a été meilleure chez les patients plus jeunes que chez les patients plus âgés (30,6 % c. 51,5 % pour la mortalité globale et 27,5 % c. 38,4 % pour la mortalité spécifique au cancer, p < 0,0001). Conclusion : Malgré un stade plus avancé et un grade plus élevé, les cas de CCR chez les patients plus jeunes ont présenté une issue oncologique plus favorable que chez les patients plus âgés assortis selon le stade de la maladie, ce qui peut s'expliquer du fait que les patients plus jeunes ont reçu un traitement plus agressif. Il faudra approfondir la recherche sur les pratiques thérapeutiques optimales chez les patients jeunes atteints de CCR., Colorectal cancer (CRC) is the third most commonly diagnosed malignant disease in both the United States and Canada. (1,2) Although epidemiologic reports have shown a decline in CRC in those [...]

PURPOSE: The International Duration Evaluation of Adjuvant Chemotherapy (IDEA) collaboration showed no significant clinical difference in outcomes in patients with stage III colon cancer (CC) treated with 3 versus 6 months of oxaliplatin-based adjuvant chemotherapy (O-ACT). We aimed to assess change in real-world practice patterns before and after publication of the IDEA study. METHODS: This retrospective cohort study included patients age ≥18 years with stage III CC diagnosed between January 1, 2012, and December 31, 2020. Eligible patients received >1 dose of ACT between March 20, 2012, and May 10, 2021 inclusive. They were categorized into pre-IDEA (diagnosed before March 31, 2018) and post-IDEA (diagnosed on or after April 1, 2018) groups. The primary outcome was the median duration and type of ACT and factors associated with a shorter duration. Secondary outcomes were 2-year overall survival (OS) and cancer-specific survival (CSS). RESULTS: In total, 740 patients were included (median age, 64 years, range, 27-90; 52.7% male). 48.8% had pT4 and/or pN2 disease. 77% received O-ACT. In the post-IDEA era, capecitabine plus oxaliplatin (CAPOX) ACT use increased (22.8%-50.7%, P <.001), and median duration of treatment was significantly shorter (2.7 v 4.8 months, P <.001). Factors associated with shorter O-ACT duration included diagnosis in the post-IDEA era (odds ratio, 2.08, P =.002), absence of pT4 and/or pN2 disease (hazard ratio [HR], 1.71, P =.01), and receipt of CAPOX (HR, 2.58, P <.001). Two-year OS and CSS were comparable between pre- and post-IDEA eras (OS 95% v 94%; CSS 96% v 96%). CONCLUSION: Our study shows that the results of the IDEA trial have been largely adopted in clinical practice with shorter duration of ACT in low-risk stage III CC. [ABSTRACT FROM AUTHOR]

Simple Summary: This study looked at different ways to predict the risk of colorectal cancer using blood tests. Sixteen studies from 2015 to 2024 were reviewed, focusing on people with an average risk of cancer who were undergoing a colonoscopy for screening. The most common test was a complete blood count, which showed good accuracy. Other tests included tests of proteins, metabolites, enzymes, and markers related to insulin and anemia. The best results came from a test using a group of plasma metabolites. While these tests could make cancer screening more accurate, many studies did not show how these models could be used in real-life settings. More research is needed to understand how these models can be effectively used in current screening programs. Background/Objectives: Risk prediction models (RPMs) for colorectal cancer (CRC) could facilitate risk-based screening. Models incorporating biomarkers may improve the utility of current RPMs. We performed a systematic review of studies reporting RPMs for CRC that evaluated the impact of blood-based biomarkers on clinical outcome prediction at the time of screening colonoscopy in average-risk populations. Methods: We conducted a search of MEDLINE, Web of Science, and PubMed databases from inception through April 2024. Studies that developed or validated a model to predict risk of CRC or its precursors were included. Studies were limited to those including patients undergoing average-risk CRC screening. Results: Sixteen studies published between 2015 and 2024 were included. Outcomes included CRC (16 studies) and high-risk adenomas (1 study). Using a complete blood count was the most common biomarker and was able to achieve an AUC of 0.82 and a specificity of 0.88. Other blood-based biomarkers included were various serum proteins/metabolites/enzymes, plasma metabolites, insulin-related factors, and anemia markers. The highest-performing model, with an AUC of 0.99, involved the use of a plasma metabolite panel. Conclusions: The evidence base of RPMs for CRC screening is expanding and incorporating biomarkers, which remain a prominent aspect of model discovery. Most RPMs included a lack of internal/external validation or discussion as to how the model could be implemented clinically. As biomarkers improve the discriminatory potential of RPMs, more research is needed for the evaluation and implementation of RPMs within existing CRC screening frameworks. [ABSTRACT FROM AUTHOR]

BackgroundCosting studies are useful to measure the economic burden of cancer. Comparing costs between healthcare systems can inform evaluation, development or modification of cancer care policies.ObjectivesTo estimate and compare cancer costs in British Columbia and Ontario from the payers' perspectives.MethodsUsing linked cancer registry and administrative data, and standardized costing methodology and analyses, we estimated costs for 21 cancer sites by phase of care to determine potential differences between provinces.ResultsOverall, costs were higher in Ontario. Costs were highest in the initial post-diagnosis and pre-death phases and lowest in the pre-diagnosis and continuing phases, and generally higher for brain cancer and multiple myeloma, and lower for melanoma. Hospitalization was the major cost category. Costs for physician services and diagnostic tests differed the most between provinces.ConclusionsThe standardization of data and costing methodology is challenging, but it enables interprovincial and international comparative costing analyses.

Simple Summary: Both a real-world meta-analysis and our multicenter retrospective analysis suggest that omitting esophagogastroduodenoscopy (EGD) in specific hepatocellular carcinoma (HCC) patients is a safe and cost-effective strategy for those undergoing atezolizumab with bevacizumab (A+B), without leading to an elevated risk of bleeding complications. In our study, conducted in Canadian centers during the early access period of A+B, 30% of patients did not undergo pre-treatment EGD. This clinical decision was often based on the absence of cirrhosis, significant thrombocytopenia, or a low likelihood of portal hypertension, as assessed by their physicians. Despite the absence of standardized guidelines and the use of an individualized approach to EGD screening, patients did not experience negative treatment outcomes or worse survival. Our data also indicated that bleeding complications associated with A+B treatment are predominantly non-GI in nature. There may be several reasons not to use EGD routinely in this setting, which include a balance between patient risks and healthcare resources. EGD is an invasive procedure that requires sedation and carries a small risk of complications, along with potential discomfort and anxiety. The limited availability of expert endoscopists' time could also lead to significant delays in initiating effective therapy in the advanced HCC setting where A+B has been shown to prolong life. The IMbrave150 trial established atezolizumab with bevacizumab (A+B) as standard care for hepatocellular carcinoma (HCC), recommending an esophagogastroduodenoscopy (EGD) within 6 months of treatment initiation to prevent bleeding from esophagogastric varices. The necessity of mandatory EGD for all patients remains unclear. We retrospectively analyzed 112 HCC patients treated with A+B at five Canadian cancer centers from 1 July 2020 to 31 August 2022. A+B was the first-line therapy for 90% of patients, with median overall survival at 20.3 months and progression-free survival at 9.6 months. There was no survival difference between patients with bleeding and those without. Before A+B, 71% (n = 79) of patients underwent an EGD within 6 months, revealing varices in 41% (n = 32) and requiring intervention in 19% (n = 15). The overall bleeding rate was 15% (n = 17), with GI-specific bleeding occurring in 5% (n = 17). In the EGD group, GI-specific bleeding was 6% (n = 5) while in the non-EGD group, it was 3% (n = 1). Non-GI bleeding was observed in 10% (n = 11) of patients. Outcomes for HCC patients treated with A+B in Canada were comparable to IMbrave150. There was no increase in GI bleeding in patients without pre-treatment EGD, possibly supporting a selective EGD approach. [ABSTRACT FROM AUTHOR]

Simple Summary: The combination of chemoradiotherapy followed by surgery (trimodality therapy) is considered standard of care for patients with locally advanced esophageal adenocarcinoma, but many potential candidates for surgery receive curative-intent chemoradiotherapy alone. This study compared the outcomes of patients who received trimodality therapy to those who received curative-intent chemoradiotherapy. Our primary analysis found that trimodality therapy reduced the risk of local tumor recurrences, but we did not detect statistically significant differences in the risks of distant metastases or mortality. These results can help patients and clinicians make informed treatment decisions, although further studies are needed to refine our understanding of the trade-offs between the two treatment strategies. The optimal management of patients with locally advanced esophageal adenocarcinoma is unclear. Neoadjuvant chemoradiotherapy followed by esophagectomy (trimodality therapy) is supported as a standard of care, but definitive chemoradiotherapy is frequently given in practice to patients who may have been surgical candidates. This multi-institutional retrospective cohort study compared the outcomes of consecutive patients diagnosed with stage II to IVA esophageal adenocarcinoma between 2004 and 2018 who planned to undergo trimodality therapy or definitive chemoradiotherapy. A total of 493 patients were included, of whom 435 intended to undergo trimodality therapy and 56 intended to undergo definitive chemoradiotherapy. After a median follow-up of 7.3 years, trimodality therapy was associated with a lower risk of locoregional failure (5-year risk, 30.5% vs. 61.3%; HR, 0.39; 95% CI, 0.24–0.62; p < 0.001 ) but not distant metastases (5-year risk, 58.2% vs. 53.9%; HR, 1.21; 95% CI, 0.77–1.91; p = 0.40 ). There were no differences in overall survival (HR, 0.78; 95% CI, 0.56–1.09; p = 0.14 ) or cancer-specific survival (HR, 0.83; 95% CI, 0.57–1.21; p = 0.33 ). Findings were consistent on propensity score-matched sensitivity analyses. In conclusion, trimodality therapy was associated with a lower risk of locoregional failure, but this did not translate into a significantly lower risk of distant failure or improved survival. Further studies are required to accurately estimate the trade-offs between the two treatment strategies. [ABSTRACT FROM AUTHOR]

There is limited information on the treatment trajectory and outcomes of patients with advanced cEGFRm NSCLC treated with osimertinib in routine clinical practice in Canada. By using and analyzing population-based administrative data and detailed chart abstraction in the province of Alberta, our objective was to capture Canadian-specific real-world treatment patterns, health outcomes, and healthcare resource utilization (HCRU) in advanced cEGFRm NSCLC patients who were (a) treated with osimertinib and (b) those receiving treatment after osimertinib. In our study cohort, we found that the overall survival rates for real-world patients receiving osimertinib were less favorable than those observed in clinical trials (24.0 versus 38.6 months). The attrition rate after osimertinib was substantial and high HCRU persisted across many years after diagnosis and treatment. This study provides important real-world evidence on contemporary survival, treatment patterns, and healthcare use among cEGFRm NSCLC patients treated with osimertinib and suggests that further research efforts are needed to improve therapeutic options in both the first and subsequent line settings. [ABSTRACT FROM AUTHOR]