The incidence of colorectal cancer (CRC) in younger people is rising rapidly worldwide, with Australia having the highest rates. This cohort faces delayed diagnosis, resulting in late-stage presentation and is the cause of highest mortality among young adults in Australia. The burden of young-onset CRC (yo-CRC) extends beyond the individual, impacting families, society, and the economy. Viewing yo-CRC as a distinct entity can address its unique challenges and improve outcomes.
Historically, metastatic CRC in younger populations has had poor survival rates, ranging from 13-23% at five years. However, a coordinated, comprehensive approach could significantly improve outcomes. We propose a holistic care model that surrounds the patient with various support systems, including care navigators, exercise physiology, mental health support, fertility preservation, survivorship care, and post-treatment surveillance. Multidisciplinary teams (MDTs) with expertise in managing yo-CRC should be accessible, and patients should be involved in MDT discussions.
Dedicated, real-time registry for yo-CRC, the Registry of Incidence, Interventions, and Outcomes (RIIO), is proposed to collect comprehensive data, drive research and establish feedback mechanisms for MDTs. This registry would facilitate rapid adaptation of treatments, improve outcomes, and foster research collaboration.
There are significant disparities in clinical practice affecting young patients, particularly those with metastatic CRC. With the incidence of yo-CRC expected to increase, there is an urgent need for a national roadmap to address this challenge comprehensively, optimising existing care elements and implementing new changes.
Key elements include understanding causative factors, developing targeted screening guidelines, minimising treatment toxicity, ensuring fertility preservation, reviewing advanced stage disease treatment, and establishing a national registry. Additionally, care navigators and post-treatment surveillance incorporating circulating tumour DNA (ctDNA) could significantly enhance patient care. Addressing palliative care needs and improving survivorship programs are also crucial. The proposed roadmap aims to redefine cancer care for yo-CRC patients and improve outcomes for future generations.