Patient-reported outcomes in physical, cognitive, and sexual health in early-onset gastrointestinal cancers (EOGIC).
Authors: Feldt Susan , Nimer Jenna , Shaik Afnan , Polite Blase N. , Liao Chih-Yi , Chin Janet , Amin Manik A. , Franses Joseph Wang , Neerukonda Anu Radha , Desgardin Aurelie , Nambiar Chetan , DuVall Adam , Shergill Ardaman 
Published: January 2025

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Background:
Incidence of early-onset (ages 18-49) gastrointestinal cancers is alarmingly increasing. To assess unmet needs in health-related quality of life (HRQoL), we conducted this pilot study using PRO measures in patients with EOGIC.
Methods:
Patients ages 18-49 with any GI cancer seen at our center during a clinic visit were invited to participate in this cross-sectional study. Validated PRO tools PROMIS 29+2, GP5 from FACT-G, AYA Sexual Health PRO Battery and Adult Neuro-QOL Cognitive Function short form were administered. Participants’ PROMIS 29+2 responses were scored to generate a T score, and two-tailed t-tests were used to compare T scores with the average score from a large general US population. The electronic medical record was reviewed to collect demographic, diagnosis and treatment information.
Results:
39 (85% response rate) patients were enrolled from 03-08/24. Table 1 describes demographics, diagnoses, and treatment. In the PROMIS 29+2, EOGIC patients reported significantly lower physical function and higher anxiety, depression, fatigue and pain interference compared to the general US population: t-score (T-test p-value) 40.4 (p 0.0003), 57.7 (p 0.005), 55.7 (p 0.017), 55.1 (p 0.033) and 58.5 (p 0.0001), respectively. 56% reported being at least somewhat “bothered by side effects of treatment,” and this measure has a known correlation with clinician reported adverse events. Regarding sexual health (SH) in prior 30 days, 79% of participants felt less whole or “damaged” due to their disease, 64% were sexually active, 56% had some distress due to change in SH, and 50% were worried about their romantic relationship(s). Patients identified discussing safe sex with low counts, body image, contraception and addressing sexual problems as areas of unmet need during their care. They reported not receiving counseling from their care teams: only 15% discussed safe sex with low counts, 28% contraception, 13% STI prevention, and 18% discussed effect of cancer on body image. No significant change in cognitive functioning over the preceding 7 days was reported in this study.
Conclusions:
PROs are an important tool in clinical and survivorship care of young patients with GI cancers. We discovered that decreased physical function, increased anxiety, depression, fatigue and pain significantly effect HRQoL patients with EOGIC. We also found high unmet need to address sexual health in patients with EOGIC. Our ongoing work aims to better understand and address these needs for our patients.

Demographic, diagnostic, and therapeutic characteristics of participants.

Age
At study participation
24-49
median 43

Gender
Female
26
66.7%

Primary cancer
Colorectal
19
48.7%

Pancreatic
5
12.8%

Biliary tract cancers
5
12.8%

Esophageal/Gastric
3
7.7%

Other (including anal, NET, GIST, appendiceal)
7
17.9%

Stage
Metastatic
22
56.4%

Treatment
On any active treatment
24
61.5%

On chemotherapy
20
51.2%