Symptom Burden and Time from Symptom Onset to Cancer Diagnosis in Patients with Early-Onset Colorectal Cancer: A Multicenter Retrospective Analysis

: The incidence of colorectal cancer (CRC) is decreasing in individuals >50 years due to organised screening but has increased for younger individuals. We characterized symptoms and their timing before diagnosis in young individuals. : We identified all patients diagnosed with CRC between 1990-2017 in British Columbia, Canada. Individuals <50 years ( = 2544, EoCRC) and a matched cohort >50 ( = 2570, LoCRC) underwent chart review to identify CRC related symptoms at diagnosis and determine time from symptom onset to diagnosis. Across all stages of CRC, EoCRC presented with significantly more symptoms than LoCRC (Stage 1 mean ± SD: 1.3 ± 0.9 vs. 0.7 ± 0.9, = 0.0008; Stage 4: 3.3 ± 1.5 vs. 2.3 ± 1.7, < 0.0001). Greater symptom burden at diagnosis was associated with worse survival in both EoCRC ( < 0.0001) and LoCRC ( < 0.0001). When controlling for cancer stage, both age (HR 0.87, 95% CI 0.8-1.0, = 0.008) and increasing symptom number were independently associated with worse survival in multivariate models. : Patients with EoCRC present with a greater number of symptoms of longer duration than LoCRC; however, time from patient reported symptom onset was not associated with worse outcomes.